Medical Topics – education and deconstruction.com

one THOUSAND wells (sic)

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The Book of the Week is “one THOUSAND wells (sic), How an Audacious Goal Taught Me to Love the World Instead of Save It” by Jena Lee Nardella, published in 2015.

Born in the early 1980’s, the American author– raised in a strict Christian household– became an idealist, passionate about helping the downtrodden. By her teens, she was volunteering at a Colorado Springs homeless shelter. She worked at an orphanage in Tijuana. In college, she got to meet and work with the Christian music-band, Jars of Clay.

Together with other groups over the course of a decade, the do-gooders who formed a humanitarian organization in 2005 called Blood: Water Mission, would bring uncontaminated blood (for medical purposes) and water (for basic drinking and cleaning) to various underprivileged communities in Kenya, Rwanda, Central African Republic, Uganda, and other African countries. They would help them with the three major components of improving Africans’ health: clean water, hygiene and sanitation.

One of the first of many, many things the author learned in her quest to save lives, was that most Americans’ first impulse is to throw money at a complex problem to solve it. They mean well, but their white-savior-complex is a wrong-headed approach. As she gained experience in providing international aid to poverty-stricken, poorly-educated rural communities, the author saw how villagers were initially skeptical about aid workers’ promises; in the past, so many aid workers had failed to follow up or do anything.

The author’s group eventually elicited a grateful, cooperative response because an educator involved the villagers in raising their own standards of living. A few different aid groups who handled various aspects of a water project, did what they said they would do.

If their projects succeeded, women and children (before school– if they were lucky enough to attend) wouldn’t have to spend hours every day trekking on foot to a water-well or river (which might be used by hundreds of households, and was usually polluted with germs and who knows what else) located many kilometers from their living areas. Blood: Water completed one specific project in Rwanda that allowed eighteen hundred villagers to partake of clean water. Such a basic victory produced a great ripple effect in the community. School attendance soared because:

kids were neither fatigued by water-fetching nor plagued by water-borne illnesses (and all the people by other illnesses, for that matter) anymore;
villagers were neither sickened by, nor dying from the water they used; and
villagers had more time on their hands.

However, the author had rude awakenings on various fronts– a water project that failed, fund-raising struggles, and an episode of corruption by a local male aid-coordinator. She was also forced to do some soul-searching on her religious beliefs. She finally had to accept that it is better to have unanswered questions than unquestioned answers.

Read the book to learn a wealth of additional details about all of the above.

Gynecologist Reflections

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The Book of the Week is “Gynecologist Reflections” by Robert A. Siegel, published in 2017. As is well known, until about the 1970’s, an American medical doctor was a trusted family friend, a generalist. The author started medical school at the dawn of that decade, and ultimately chose obstetrics and gynecology as his specialty. In this poorly edited volume, the author detailed his memorable patient-cases inside America’s changing medical industry amid changing cultural and economic times.

During his training, the author was required to perform abortions; if he didn’t, he’d be fired. Another medical institution wouldn’t accept him and he wouldn’t become a physician. He acknowledged the very emotionally charged, controversial nature of the procedure, and controversial nature of not only when life begins, but when it ends.

The author’s generation of medical interns was still male-dominated. According to the book (which appeared to be credible although it lacked a detailed list of Notes, Sources, References, Bibliography and an index), most of the interns were brainwashed into thinking that working around the clock, saving lives on eight hours of sleep a week, was a macho thing to do. Of course, in the next few decades, American medicine became an increasingly litigious line of work and its trainees rebelled against the abusive hierarchy.

After about a decade, the author was able to make a living as a solo practitioner treating private patients. But his dedication to his work (which often involved emergencies) still left him severely sleep-deprived and very stressed. He admitted to coming quite close to making a medical mistake that would have resulted in a patient’s kidney failure. Fortunately, his assistant asked him a simple question about the task at hand.

In another instance, the doctor bragged about saving the lives of a woman and her later prematurely-delivered baby who were in a serious car accident. He got all the kudos, but explained that the surgical team, the technology and the hospital were just as responsible for the positive outcome.

The doctor also recounted a legal case of an acquaintance of his (who was also a doctor). The acquaintance gave verbal instructions, which the mother of the patient (a young child who apparently died through no fault of the doctor’s) failed to follow. He wrote, “You should have seen this lady. She was reeking of alcohol but we weren’t allowed to say that in court…” The initial jury-award unexpectedly, outrageously exceeded his malpractice insurance coverage.

Read the book to learn about: hemorrhages, caesarean sections, hysterectomies, OB-GYN screening tools, etc., plus the sociological aspects of the doctor’s practice, and biographical info on him– including how he almost died at a young age (hint: he led an unhealthy lifestyle to say the least– “Two days before my double by-pass was scheduled, I signed myself out [of the hospital] against medical advice.” Exhibiting arrogance and a feeling of invincibility, no doubt.).

No Such Thing As A Bad Day

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The Book of the Week is “No Such Thing As A Bad Day, A Memoir” by Hamilton Jordan (NOT to be confused with Jim Jordan or Vernon Jordan), published in 2000. This volume was a mishmash of a few topics, including his bouts with cancers, a bit about his political career, and his uncle’s civil rights activism. He claimed not to be an attention whore, but the book’s front cover featured a photo of his face, and the back cover, a photo of him with his family.

During the Vietnam Era, the author’s friends at the University of Georgia were either members of ROTC or the National Guard. In 1967, at 23 years old, he joined International Voluntary Services (an organization sort of like the Peace Corps) to help the Vietnamese people grow rice.

The author was a tad insecure, apparently feeling the need to engage in name-dropping of celebrities, even though he must have met a huge number of them in his lifetime; he worked for Jimmy Carter, before and during the time Carter was president. He wrote, “Roy Cohn practiced law in New York City… representing some celebrity (like Donald Trump) in some highly public divorce settlement or scandal.” In August 1979, the FBI showed up at the author’s home, in connection with cocaine and Studio 54 in New York City.

The author then described his uncle Clarence’s civil-rights activities, that in the mid to late 1950’s, consisted of organizing a biracial Baptist commune with tens of residents, called Koinonia in rural Georgia (the state of the United States). Clarence was just trying to practice what Christians preached, but (excuse the cliche) no good deed ever goes unpunished. As can be imagined, Clarence was doing the wrong thing in the wrong place at the wrong time.

One last interesting factoid: According to the book (which appeared to be credible although it lacked Notes, Sources, References, Bibliography and an index) when Bill Clinton was a newly elected president, the author advised aide George Stephanopoulos to recommend that Clinton get rid of the Independent Counsel law. That law had been a thorn in the sides of presidents Reagan, George H.W. Bush and others, and continues to be. Enough said.

Read the book to learn various other details about the above, and about the author’s bouts with cancers.

After A Stroke

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The Book of the Week is “After A Stroke, 300 Tips for Making Life Easier” by Cleo Hutton, published in 2005. The author of this short paperback had a stroke in 1992, but gives many tips that are still relevant to recovery from an event that adversely affects the brain, and therefore, specific body functions– that commonly impair one side of the body.

In recent decades, a huge amount of attention has been paid, and money spent on research for: raising awareness of stroke prevention and symptoms, treatment, and the introduction of products to make activities of daily living easier for stroke patients.

The author briefly discussed the neurological effects of a stroke, which are on a continuum; every patient is different. She explained that “constraint-induced therapy” helps a patient’s brain transmit messages through alternate neurological routes through the unaffected side of the body.

The author listed the common frustrations and situations recoverers might encounter:

feeling overwhelmed by everyday decisions, such as product-selections while shopping (in the United States, especially!);
loquaciousness upon regaining the ability to speak;
linguistic impairments such as usage of expletives in speech due to groping for the correct word– even for patients who wouldn’t normally utter them, or inability to understand idioms;
personality change;
seeing specific items in certain situations that prompts crying or laughing at inappropriate times due to damage to the visual association cortex.

The author recommended keeping aspirin in the freezer to help keep it fresh, if one is taking it.

Read the book to learn a slew of other useful tips for facilitating dealing with: the emotional problems arising from bodily impairments, getting around, communicating, cooking, eating, taking care of the home and one’s body, etc., etc, etc.

Black Box Thinking

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The Book of the Week is “Black Box Thinking, Why Most People Never Learn From Their Mistakes– But Some Do” by Matthew Syed, published in 2015. This volume attempted to answer the question: “How does failure-denial become so deeply entrenched in human minds and systems?”

The author described two ways of thinking:

1. Some people believe their abilities are fixed, so they won’t improve with practice. They have fear of failure, and make excuses and / or blame others for their failures.

2. Other people believe they can get better with practice, and they are honest about admitting they have made errors. They learn from them. Success is achieved only through trial and error, hard work and persistence.

Number 1 above is also described in the following quote from Bertrand Russell: “There is something feeble and a little contemptible about a man who cannot face the perils of life without the help of comfortable myths. Almost inevitably some part of him is aware that they are myths and that he believes them only because they are comforting. But he dare not face this thought! Moreover, since he is aware, however dimly, that his opinions are not rational, he becomes furious when they are disputed.” Yet another way of putting it is “hubris syndrome.”

Two of America’s recent presidents– George W. Bush and Donald Trump– were this kind of thinker. According to the author’s thesis, they succeeded against the odds (if success is defined as getting elected president), considering that they were blind to their own character flaws.

BUT– their common beginnings saw them through: They both began with the special advantages of inheriting money, mentors, lawyers, and valuable career and political contacts. They proceeded to fail upwards until they reached their peak “Peter principle” level, kind of like the joke: How do you make a small fortune in Israel? Answer: Come with a large one.

The author drew parallels between the topic-areas of aviation and healthcare delivery. These involve life-and-death scenarios when things go extremely wrong. However, that is where the similarities stop. People who have shaped the evolution of aviation have built up a knowledge-base that has served to produce lower and lower death tolls when catastrophes have occurred; powerful, influential people working in healthcare have been stubbornly resistant to adopting measures that would result in a drastic reduction in unnecessary deaths.

The author cited real-life examples from Great Britain and the United States. But there are other major reasons why his comparison is mostly invalid. These involve lawsuits, unions, government regulations and the political climate at the time of the disasters, and the following:

Obviously, workers in aviation have more of an incentive to improve safety, because in a disaster, many more people might die all at once in a plane crash, compared to the one patient on an operating table or examination table. Even if members of the flight crew survive a disaster, their careers are likely over. Even when doctors are at fault, they usually continue their careers.

The author discussed the pros and cons of just-culture versus blame-culture. He described the latter thusly: “It may be intellectually satisfying to have a culprit, someone to hang their disaster on. And it certainly makes life simple.”

The author recounted how a public-relations campaign can fool even intelligent people into believing a particular method of crime-prevention among young people, works wonders. The only way to debunk such a myth is through numerous Randomized Control Trials.

Read the book to learn about additional concepts surrounding psychological self-deceptions that humans employ in order to avoid admitting failures: cognitive dissonance, narrative fallacy, top-down versus bottom-up product development, various biases, and others.

A Primate’s Memoir

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“Hearty, strong, large people who ate like hogs and worked like mad and filled their few leisure hours with hexes and witchcraft and clan feuds and revenge curses.”

No, not American political workers.

The above described the tribes such as Masai and Kisii– born in British East Africa. According to the book (which appeared to be credible although it lacked an extensive list of detailed sources, and an index), the warrior-tribes fought against each other, and on behalf of Britain during the world wars and against other tribes in Tanzania, Somalia and Uganda, near the Kenya borders, into the late twentieth century.

The Book of the Week is “A Primate’s Memoir, A Neuroscientist’s Unconventional Life Among the Baboons” by Robert M. Sapolsky, published in 2001.

Starting in 1979, on and off, over the course of fifteen years, the author began observing a 63-member troop of baboons in Kenya. He learned about every aspect of their lifestyles. He made many errors in attempting to acquire experience anesthetizing them in order to test their bodily fluids and excretions. He finally learned how to shoot a tranquilizer dart from a blowgun, but even that had its complications.

The author also gathered a vast quantity of knowledge about the Masai tribe in the village. The women there were voicing their opinion that their children should receive a formal education. However, at that time, there were no supplies, no teachers, and most school buildings could be tens of miles away from villages. Even when progress was made on that front, the Masai men used their children’s school fees to buy alcohol.

The men felt entitled to be leaders in their communities, where they did almost no work. Herding cows and goats and deriving food from the animals was the mainstay of the Masai economy. The women did the housework and childcare; the boys did the herding until they became men, and in their late twenties, they were considered village-elders deserving of respect.

The Masai associated the author– a white male in his twenties– with someone who was knowledgeable about providing medical treatment to their people. He looked all official, with a box of bandages and a stethoscope. So he was pressured into dispensing the few drugs he had for a few different maladies, such as chloroquine for malaria and antibiotics for eye infections.

After a couple of years of graduate-school fieldwork, the author noted that there was no clear-cut “second banana” to the alpha male of the baboon troop. In fighting, the males bit each other using their sharp canine teeth in addition to pummeling each other with their fists.

As the years went by, two lower-level males– afraid of the top leader– formed alliances, but the leader was still sufficiently physically powerful to dominate them. The two allied with a third male, but all three were still too weak to stand up to the top baboon. They partnered with an old-timer male. It took a little longer for the boss to put them down. Finally, six males banded together and defeated the alpha male.

Read the book to learn much, much more about the lifestyles of the baboons, the Masai, and about how powerful-people were never caught and punished for knowingly spreading a plague among some baboons (Hint: “The meat was dutifully sold [by the Masai to the butcher], everyone became sick. The police came to investigate…”)

As can be seen from the aforementioned, the baboons have a social system largely similar to humans’. Here’s a little ditty one alpha male (Donald Trump) is singing now.

NO ONE WILL EVER

sung to the tune of “Nobody Told Me” with apologies to the Estate of John Lennon.

My foes are always talking. What they say is absurd.

America, I love. About you I really care.

There’s Socialists in the White House. Now we have Wall Street bears.

The IRS is out to get me. But my campaign is going on.

I always have something cooking. I foil all their evil plots.

They sent us disease from China. I started the Wall we’ve got.

No one will ever bring me to my knees.

Kudos to me. Kudos to me.

In ’24 I’m runnin’. No one else has made a move.

I’LL be the winner. I’ve still got lots to prove.

I’m a big super hero to all who are good and true.

Everybody’s on a witch hunt, and hauling me into court.

I’m a privileged leader. That’s my retort.

I belong in a million movies. But too bad. Life is short.

No one will ever bring me to my knees.

Kudos to me. Most excellent, MAGA.

The economy’s doing poorly. Prices are getting HIGH.

The liberals are crying. They’re eating humble pie.

All of them are liars, and I ain’t too surprised.

No one will ever bring me to my knees.

Kudos to me. Most excellent, MAGA. Whoa.

The Emergency

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The Book of the Week is “The Emergency, A Year of Healing and Heartbreak in A Chicago ER” by Thomas Fisher, published in 2022.

At the start of the COVID-19 pandemic in 2020, friendly bedside manner disappeared in the Emergency Room of the author’s employer, a medical center affiliated with the University of Chicago, on Chicago’s South Side. The author, a medical doctor, was tasked with judging whether to put newly arrived patients on ventilators.

Already a stressful place, the Emergency Department was put under excessive tension when an edict was issued that everyone entering the building was required to cover his or her mouth and nose (with any old piece of germy fabric or a plastic shield; most wore the fabric). The authorities perpetuated the scientifically questionable assertion that covering one’s face (with anything) would stem the spread of disease.

BUT, requiring the country’s entire population to wear medical masks would be impractical and unenforceable. There wouldn’t be enough medical masks for everyone; meaning, masks that would filter one’s toxic exhalations, allow one to breathe relatively easily, while presumably, disallowing most germs from entering and exiting one’s mouth and nose. So, instead, across the country, there was rampant abuse of power by numerous officials in controlling the population with petty, dishonest mask-orders.

Anyway, a nearby Chicago hospital had no more ventilators, and another had only three on hand. A patient might not have COVID, but still might be struggling to breathe because she had heart failure from postpartum cardiomyopathy. The author decided to treat a young patient such as this one with magnesium, additional Lasix and nitroglycerin instead of a ventilator, because she would be more likely to survive than an older patient in poor health who had severe COVID.

“Still, too many physicians and scientists accept that the inequities around us emerge from inside the body we treat, rather than in relation to prevailing societal structures or systems… But it is society that shapes the population-wide patterns we see.”

This volume presented, in a series of anecdotes on the patients admitted and treated by the author, reasons why this country desperately needs NATIONAL HEALTHCARE. It is the right thing to do at this time in history. Other reasons can be found in this blog’s posts:

Morphine, Ice Cream, and Tears. (sic); Chasing My Cure; Clinging to the Wreckage; and I Shall Not Hate.

Read the book to learn of the physical and psychological traumas suffered by not just patients, but also caregivers, that could be prevented or minimized by improving policies in national healthcare in the United States.

Dr. Folkman’s War

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The Book of the Week is “Dr. Folkman’s War, Angiogenesis and the Struggle to Defeat Cancer” by Robert Cooke, published in 2001.

In the 1970’s, Judah Folkman was a competent surgeon and a very popular professor at Harvard Medical School, but his first love was medical research. He hypothesized about why and how a tumor grows. He inferred that blood vessels grow toward a tumor, but was unable to provide proof for a very long time. He was ostracized for having this radical idea, so he had difficulty attracting enthusiastic graduate students to assist him, and with getting funding for his research.

Traditionally, university medical studies in laboratories had been funded by government grants. Profiteering from patents and medical products resulting from research was considered sleazy in scientific circles. In 1974, Harvard broke the taboo and partnered with the large, profit-making organization called Monsanto.

Even after receiving generous funding, Dr. Folkman worked around the clock simply because making new medical discoveries requires months or years of blood, sweat and tears. The materials required to do experiments can be expensive, messy, odorous and pose unanticipated problems. For a while, Folkman’s lab was working with vast quantities of cow and shark meat (and other obscure, problematic materials) because the animals’ cartilage contains no blood vessels.

Even after the doctor’s studies yielded exciting breakthroughs, media articles influenced the medical community and the public in ways that were harmful to Folkman’s research operations. There were even accusations of fraud against him. It turned out that in his team’s haste to treat cancer patients, many errors were made. Time was of the essence, and procedures for organized data collection were lacking. Folkman wasn’t deliberately trying to deceive anyone.

Folkman was a rare bird in that he was quite altruistic with his time and talents. His patience and persistence allowed him to ignore his detractors and the naysayers (most of whom were jealous). He eventually acquired an area of expertise that not only spawned a new way of thinking about cancer treatment, but also led to treatments for other medical conditions, and whole new industries, including biotech. He also helped shatter a myth in cancer treatment. But this additional idea of Folkman’s still might not be fully accepted in oncology circles (due to GREED), even two decades after the writing of this book.

This is what he learned: The approach to cancer-drug delivery to a tumor of:

“low [dosage] and slow [buildup over the long-term]” was shown to be superior to

“might makes right” and come in with guns blazing; in the past, it was hoped that immediate, large doses would eliminate the tumor before metastasis, and before the patient died from the deaths of too many healthy cells that were also killed in the process.

In other words: The patient’s treatment should begin with a low drug dosage, and if that proves ineffective, increase the dosage gradually until it is effective. Folkman’s experiences with patients showed that that was the successful way to go, and he even saw a few miraculous cures.

Read the book to learn many more details on Folkman’s trials and tribulations and the reasons for them, and what transpired when he finally found vindication.

Burn Rate

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The Book of the Week is “Burn Rate, Launching A Startup and Losing My Mind” by Andy Dunn, published in 2022. Born in February 1979 in the United States, the author won the lottery in that he had family and friends who knew him well enough to recognize that, given his personality, his behavior was anomalous. He was doubly lucky that not only did he get mental-health treatment before he ended up in jail (well, at least on one occasion) or in the cemetery, but also, he could (with assistance from others) afford it.

“… for many, even a ‘chill’ drug like marijuana can stimulate a manic episode.” The author got to college still unaware that bipolar disorder (aka manic-depressive illness) ran in his family; his grandmother had had it. People who actually have the condition suffer under a Damocles sword their whole lives, as their mental state goes through unpredictable cycles, even with medication. Of course, stress exacerbates the highs and lows. The medication has side effects that are meant to dull the emotions, so bipolar patients don’t experience and enjoy life as much as people whose brain chemicals are more stable than theirs.

According to the book (which appeared to be credible although it lacked Notes, Sources, References, or Bibliography and an index), while in college, the author was ingesting alcohol and controlled substances such as ecstasy, magic mushrooms and marijuana on a daily basis, and taking the (radical) acne medication Accutane. Somehow, he graduated anyway, and got his MBA at Stanford. He explained that the professors there educated students in entrepreneurship, if they wanted to go that route. The author did.

After years of interesting ups and downs, in 2016, the author– a lifelong fan of the Chicago Cubs (who had last been World Series winners in 1908)– was afforded the opportunity to see game 7 of the World Series in Cleveland. But first, he had to rush to JFK airport from the streets in the East 50’s in Manhattan, beginning an hour before his plane took off, to get there. His cab driver did 90 MPH. Sympathetic people at the airport made way for him when they heard about his situation.

Read the book to learn of the author’s other trials and tribulations, triumphs and defeats. Speaking of defeats…

This is the song Hillary Clinton is singing now.

IN POST-CLINTON TIME

sung to the tune of “Sunny Afternoon” (Official Audio) with apologies to the Kinks.

My opponents BEAT me the last two times.
Deplorables and BERnie were unkind.
I SOREly miss the Situation Room.
And though I CAN-not be in charge,
I’m not locked up, I’m still at-large.
All I WANT’S in-the Situation Room.

Save me, save me, save me
from bad publicity.
I’ve got lots of enemies.
It’s a VAST right-wing conspiracy.

And I love to hobnob with elites,
brag about my political feats.
I SOREly miss the Situation Room,
in post-Clinton time,
in post-Clinton time,
in post-Clinton time.

Donald Trump’s ruined my rep.
He’s in his safehouse doing ’24 prep,
spewing the usUAL blather and cruelty.
Now I’m here online,
doing the grass-roots, make-work grind.
I SOREly miss the Situation Room.

Help me, help me, help me
revive my ca-reer.
Well, give my Party money
to get me out of here.

‘Cause I love to hobnob with elites,
brag about my political feats.
I sorely miss the Situation Room,
in post-Clinton time,
in post-Clinton time,
in post-Clinton time.

Ah, save me, save me, save me
from bad publicity.
I’ve got lots of enemies.
It’s a VAST right-wing conspiracy.

And I love to hobnob with elites,
brag about my political feats.
I SOREly miss the Situation Room,
in post-Clinton time,
in post-Clinton time,
in post-Clinton time,
in post-Clinton time,
in post-Clinton time.

The Girls in the Wild Fig Tree / The Last Nomad

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The first Book of the Week is “The Girls in the Wild Fig Tree, How I Fought to Save Myself, My Sister, and Thousands of Girls Worldwide” by Nice Leng’ete, published in 2021.

According to the book (which appeared to be credible although it lacked Notes, Sources, References, or Bibliography and an index), the following is still an all-too-common scenario in a poor village in Kenya: “… it is unlikely she will finish her education [meaning– graduating what would be equivalent to grammar school in the United States]. Her father married her [off when she was] young to get a dowry. Her husband wants her home to work and raise the children.” She is fifteen years old and already has two babies.

The author’s passion is to replace the tradition of female genital mutilation (FGM) practiced by certain Kenyan tribes, with Alternative Rites of Passage. For, the culturally entrenched FGM is one major reason females in her society have been so sheltered, limited and resigned to their fate for so long.

The author grew up in a Maasai village in Kenya, near the Tanzanian border. When she was about five years old, her mother took her to witness a FGM ceremony in her community. Maasai culture dictated that when girls showed signs of puberty, they underwent the ceremony. “The cut” (of the clitoris) was extremely painful, and the presence of complications such as infection or hemorrhage could lead to chronic medical problems or even death. There were no drugs administered.

But the cut, even in the absence of physical complications, signaled the next steps of arranged marriage, childbearing and servitude for the rest of a girl’s life, usually beginning in her early teen years. Even when a girl’s mother wanted to honor her daughter’s wish to finish school and have a different lifestyle, she had no power to persuade her husband or any other male relatives to allow that to happen. The males ruled the roost.

Read the book to learn how the author escaped her almost certain dismal fate, and how she is helping other females to do the same, without their having to endure all the traumas she did.

The second Book of the Week is “The Last Nomad, Coming of Age in the Somali Desert, by Shugri Said Salh, published in 2021.

According to the book (which appeared to be credible although it lacked Notes, Sources, References, or Bibliography and an index), the author’s Muslim family was somewhat anomalous, in that her father was a multi-lingual scholar who believed in education for both genders, and her grandmother was an authoritative figure. The author was born around 1974. Her culture also still practiced female genital mutilation.

The sprawling family’s tribe was nomadic– they herded camels and goats, and seasonally migrated around the desert in Somalia, looking for water. Their religion allowed polygamy among the men. The author’s father’s biological children numbered 23 among 7 wives, 5 of whom he divorced; the author’s mother gave birth to 10 children before she passed away of malaria when the the author was six years old.

In 1988, Somalia’s government and tribes devolved into civil war. “Killing, looting, destruction, and chaos was now our norm.” The people had a complicated system of relationships in which they took care of their own family and tribe, and if their brains were poisoned by war, they became hostile to all others.

The author’s sister possessed a key survival skill– thorough knowledge of her family’s lineage so that, when questioned, she knew which tribal name to utter to quell sociopathic, armed-and-dangerous child-soldiers in the streets. When the family finally fled Mogadishu in 1991, their black-market connections allowed them to obtain provisions that kept them alive– fuel for a truck, food and ammunition. However, they braved many other life-threatening dangers, including atrocities (committed by people), harm from lions, poisonous snakes and baboons, disease and dehydration; not to mention lice and scabies.

The author and several relatives were able to cross the border and stay in Kenya temporarily. Even so, law enforcement officers in Nairobi were corrupt– arresting refugees and hitting them up for bribes just before they knew the refugees were due to legally leave the country.

Read the book to learn much, much more about the author’s checkered story.