Month: April 2023

What Has Happened To Medicine?

Richard Barnes

My prior post, Cero, told about my getting very sick on the way to a Double A baseball game in Ciudad Bolivar (CB). Cero noticed I did not look well and told my father who then drove me ahead of the team to CB where our friends took us to their family doctor who determined my ailment and I was well by the end of the day.

For decades I had not thought of Cero or the event in which he played a prominent role. The recollections were prompted by the chapter, “The Crisis In Medicine” in Harold O.J. Brown’s The Sensate Culture.

“Once considered an art and a calling, medicine has become both industrialized and commercialized. In the United States, which often serves as a bellwether for all Western culture, medical care, surgery, psychiatry, and hospital care, are advertised like automobiles and cosmetics:

“‘The University of Chicago Hospitals — at the forefront of medicine’.

“‘The only Harvard-trained specialist in male sexuality in Northern Illinois….'”

As if that weren’t unseemly enough, medicine has also become thoroughly politicized, increasingly defined as a “right of all citizens and non-citizens in modern Western states.” And since it is a “right”, the state has taken over vast swathes of the medical-industrial complex, including encouraging the “right to die”, because, after all, it is very expensive to help people live longer than public well-being actuarial tables, is it not?

(About the “right to die”, Brown remarks pithily, “It is odd to define something that everyone must do as a right.”)

Medicine is at least as ancient as the first birth of a child. “Did Adam tie Cain’s umbilical chord…?” 

The close relation between medicine and religion persists to this very day, as attested by doctors who still repeat the old slogan, “I treat; God heals”.

Another close relation that has been revived in 20th and 21st Century America is that between medicine and the state.

This is nothing new. The world’s oldest law code, The Code of Hammurabi, reflects a unified culture, centered on the throne, with the monarch playing a semi-divine priestly role. And the physician was “trained, examined, and paid by the royal household. Those who did best in their examinations could become physicians to the royal household; those who did less well, treated the nobility and wealthy citizens, while the poorest candidates treated the common people.” Nothing new here as the president and both houses of congress have medical care and benefits which are unthinkable for the rest of us.

“Medical care was available to all classes without cost….” But this state-provided care came with something with which our modern society in increasingly afflicted, “the physician was a servant of the state and was expected … to keep the monarch informed about the affairs of his subjects.”

Are you not concerned about all the “checklists” doctors or practitioners go through whenever you happen to grace their clinics or offices? I know I am. Hammurabi seems not to be so far in the past.

The Hippocratic tradition, originating in the idealistic phase of Greek culture, “proved extremely durable, even through the sensate period of Roman Empire; it was developed and reinforced in both medieval Europe and the Muslim lands of the Near East. Only in the late sensate phase of our own culture has it begun to be seriously challenged.”

“The Hippocratic Oath taught physicians to consider their work a holy calling and to hold themselves accountable to God, to their professional colleagues, and particularly to their patients.”The patient was seen to be made in the image of the divine. Outside the Hippocratic tradition, “physicians frequently worked for the monarch or the state. They had no specific duty to their patients as individual human beings in the same way that a veterinarian has no specific duty to the dogs or horses he treats but rather to the owner who pays him. Hippocrates instructed his students and all who followed in his tradition concerning their duty to the patient first of all. Specifically, the new physician promised not to perform or counsel abortions and not to perform or counsel ‘assisted suicide’.”

Significantly, in the Hippocratic tradition, the physician works for the patient; in the Babylonian, totalitarian tradition, the physician works for the state.

In our increasing sensate culture the shift in medicine has been away from the patient and to the state, as it is the state who determines who gets paid and by how much. 

Medicine touches a broad and deep range of human existence and much of modern Western human existence is sensate to the core — materialistic, utilitarian, pragmatic, irreligious, and oriented to the temporal as opposed to the eternal. We therefore ought not be surprised at the cavalier attitude so prevalent in today’s medical-industrial complex. 

However, we do have a duty to push back and, wherever possible, to seek for and provide alternatives for ourselves and for our children. Alternatives such as direct primary care, health sharing groups, and surgery centers. We are not without hope.

Surgery centers along with Direct Primary Care and Health Sharing Groups are options available to those who seek to return to a less “state-centered” medical approach

Ciudad Bolivar circa 2000

Cero

Richard Barnes

Company towns in petroleum or mining camps in Venezuela, like El Pao, had hospitals and doctors who tended employees and their families. Recently, I was prompted to think a bit about my childhood experiences and interactions with doctors and the hospital. My experience was primarily in El Pao, but also encompassed an annual check up with a doctor in Miami. I suspect my parents just wanted to sort of double check by getting a second opinion to confirm that all was well.

As I’ve told my children over the years and now tell my three youngest who are still at home, we have been blessed with good health. It is far too easy to take this blessing for granted. One should never do so.

Whenever we had to see a doctor (anemia, parasites, fevers, tonsillitis, broken collar bone, sudden nausea), depending on the urgency, we either rushed in as an emergency or made an appointment. In any case, Dr. Hernandez [a composite name serving for several doctors whose faces I can still recall and none of whose names was “Hernández”] would examine the patient and tell my parents what he had noticed and his treatment including any medicines he’d prescribe.

On one occasion, when I was about 6 or 7 years old, I was accompanying my father as he travelled with the company baseball team to play in Ciudad Bolivar, on the Orinoco River. This was before the bridges across the Caroní River were built and crossings were by ferry, making the trip much longer than it was by the time I left Venezuela.

About 40 minutes after the river crossing, the team stopped at El Kilómetro 70, a major highway intersection with a large, popular diner and gas station. I told my father to go ahead, that I’d wait for him in the pickup. I did not tell him that I was feeling very poorly because I did not want him to send me back and so cause me to miss the ballgame. 

However, “Cero”, the water boy who was one of the friendliest and kindest men I have ever known, had decided to come out and look in the pickup, “¿Te pasa algo?“

I had been curled up, not thinking anyone would see me. He startled me but even so I could not move quickly as I was in pain and, as I recall, had nausea.

He turned away and in a minute my father was opening the door and after a brief discussion he along with Cero decided to drive on ahead of the team to Ciudad Bolivar where we had friends. Regardless, this would take less time than to travel back to El Pao, river crossing and all. 

My father drove to our friends, the Graziani’s, who immediately took us to their family doctor who attended me promptly. I don’t recall what he did, but I do remember that by the time we left his office, I was hungry and at Mrs. Graziani’s house she served me the most delicious pumpkin soup ever. And I was not partial to soup. I have been blessed with the opportunity to travel to many different parts of the world. Whenever a restaurant had pumpkin soup, I’d order just to see if it equalled my childhood memory. Of course, none ever has.

My father told me later that Cero had come inside “El Kilómetro 70” and had told him that my color was not good. That caused my father to look at me more carefully when he came out to the pickup. He was impressed with and appreciative of Cero’s perceptions.

I think my father was able get to the game in time that day, but I had to stay with the Graziani’s. However, by then, I was content. I do remember his telling us our team had won.

Medicine and doctor care was very personal then. My father paid the doctor and thanked him. In El Pao, the doctors were paid by the company. In Miami, as I recall, medical costs were a bit less simple because those were paid by the company’s medical insurance; however, care and interactions were far more personal and direct than they are today.

These thoughts were prompted by the chapter, “The Crisis in Medicine” in the book, The Sensate Culture, to which I’ve alluded in an earlier post. 

My intention was to write a brief review of that chapter here, but then I remembered Cero, and it is impossible not to pay tribute to him first. Unfortunately, I do not remember his real name and my mother does not remember either. However, in his case, the nickname was purposefully the exact opposite of the man’s worth. He was respected and admired and was easy to laugh with.

After leaving Venezuela, between college studies and early career hustle and bustle, I eventually forgot about Cero. Then came the expropriations of the oil and ore enterprises in Venezuela under the first administration of Carlos Andrés Pérez and many Americans and their spouses, including my parents, left the country.

The year was 1976 and unbeknownst to my father, word had spread of his imminent departure, and the veterans of the mining camp baseball team, which my father had shepherded to AA ranking and championships, agreed to come from all points of the country and surprise him with a veterans game. Newspapers covered the event but I’ve lost the clippings.

However, several men, including Cero, did not get word of the event.

About a month later, my father and mother, along with my little brother, had begun their trek out of the country. Their first stop was Maiquetía, the international airport which serves Caracas, where they were to spend the night and then head back to the airport the next morning. As they waited for their luggage, Cero saw them and ran to them. They embraced and laughed — it had been more than a decade since Cero had left El Pao and they had lost touch. 

After asking about the rest of the family and being told that everyone is fine, Cero said, “I remember that you usually took your vacation in September. I see you now are taking it in the springtime?”

“Well, this is not a trip for vacation; we are leaving the country.”

Tears welled in Cero’s eyes, and they talked for a long time. But what I remember most from my parents’ narrative of the event was something he said amongst all the words, “Please don’t leave, Charles. This is your country. You are loved here. Don’t leave.”

I still choke up when I recall that; and I had not recalled in many years.

They embraced and parted company one last time.

Cero was worth millions.

Multi-year AA Champions. My father is in front row, far left. Cero is not pictured.

Sopa de auyama (calabaza). Hard to beat a childhood memory.

Maiquetía in better days

Morillo: Spain Seeks to Reconquer America, Part II

Richard Barnes

In my prior post, I alluded to the betrayal of General Pablo Morillo by one of the most despicable scoundrels of South America’s 19th Century revolutionary wars, Juan Bautista Arismendi. For generations, this man, like Bolivar and others, has been held up as a noble, heroic, unselfish paragon of righteousness. And, as is often the case, the writers of modern history are actually agents of propaganda. Arismendi was a cruel, pitiless spawn of 18th Century Enlightenment doctrine. Like Robespierre, he loved ideology and blood more than his fellow man, including his own wife.

One example of his coldness was his reply when informed that his wife, imprisoned for aiding the murderers, and about to give birth, “I’d rather have a country (patria) than a son.” I’ve paraphrased the quote, but that was the gist. Compare that sentiment to the motivations of the North American colonists who risked it all precisely to protect hearth and home. In the case of Mrs. Arismendi, the Spaniards released her. This, in contrast to Arismendi’s slaughter — with clubs and spears — of Criollos (Venezuelans born of Spanish parents) sick and wounded in hospitals in Caracas. Lord, spare us from ideologues!

As noted in the prior post, after the massacre of the few Spanish on the island of Margarita, Arismendi sent word to Bolivar, who was being aided by the disastrous, murderous regime in Haiti. Bolivar headed back to Venezuela, intending to stop first in Margarita to meet up with Arismendi.

En route, his squadron came across two Spanish ships which were promptly attacked in a fierce, bloody battle. The Spanish were overwhelmed and Bolivar’s men, with the War to the Death proclamation still in force, slaughtered all they came across, including a gravely wounded man in sick bay and the physician, who approached the men, seeking to calm them down, only to find himself cut down as well. 

Meanwhile, Simón Bolívar, the Great Liberator, was laughing as he practiced his aim by shooting at the castaways who sought to swim either to safety or even to Bolivar’s ships to keep from drowning. Bolívar, contrary to all laws of war and peace, shot them. Witness accounts note that he killed two in this way. I could find no record if any of the others were spared or simply abandoned in the open sea.

Witnesses affirmed that Bolívar was laughing as he shot, “He completely approves and encourages the killing of prisoners after the battle and during the retreat and has even sought to be a witness to these scenes of infamous carnage.”

Bolivar’s cruelty was well known before Morillo arrived in Margarita the prior year, 1815. Nevertheless, he had considered Arismendi to be sincere in his protestations of loyalty and ignorance, this despite Morillo’s own men urging him to not believe Arismendi as there was overwhelming evidence of his murderous character. However, Morillo waved this aside in his foolish initial desire to fight a raging fire with a spray bottle.

When he learned of Arismendi’s betrayal, of his murder of the men he had left behind, of numerous scenes of unbelievable cruelty beyond even that which he had witnessed in the Napoleonic wars in Spain, he hardened and determined to execute all ringleaders henceforth. As noted in the prior post, this is what he did in Santa Fe, despite the pitiful cries of wives and children. 

Witness accounts relate Morillo’s regret for not having listened to his men upon his initial disembarking on Margarita. He would speak of the wives and children of the men he had left to die at the hands of Arismendi and Bolivar and of the many more Spanish soldiers who perished because of his foolishness.

Morillo is treated poorly in the history books, which must create monsters to slay in order to exalt men of low degree. However, he was a far better man than Bolivar and Arismendi.

General Pablo Morillo (1775-1837)