Campesino Medicine

Of my patients

I am a physician.  Most of my patients are Mexican.

Of course, we stop and scrutinize everything that mentions another culture or country, and parse the phrases for their political correctness, so let’s, for a second.  It is politically alright to call my patients Mexicans, I’d say, for they are from Mexico.  Most are not in any sense not Mexican-Americans; excepting a brief continuation of their stay in the United States, they are here illegally, awaiting deportation to Mexico.  The few I see who have lived since childhood in the US are a whole different sort.  I treat them in English; they are completely from a different universe.  My patients are from Sonora, and Durango; from Baja California Norte, and Oaxaca.  Mostly, their “business enterprises” have brought them here; I do not discuss their “business” background.

They come from a broad range of cultures, abilities, education and origins.  Here, in the US bubble, we sketch our pictures of Mexicans with the broadest strokes.  Our image of Mexicans is really a cartoon; our amigo bueno, Gustavo Arellano will tell you that in “Ask a Mexican^®” in the Orange County Register, and in the local Alibi.   For those bothered by the logo on his column (right), one can click on it and take it up with Mr. Arellano and Mark Dancey.

I shall not dwell overmuch on political correctness in terms.  Political correctness is often called upon to fill up time in the absence of real thought, and to generate purposeless dispute and bickering, in the empty echo-chamber of modern thought.

We think of the campesino – the fieldworker – most of the time when we speak of Mexicans.  We do not think of the Museo Soumaya, a museum which contains a preponderance of the works of Rodin and other Impressionist artists in a boldly modernistic structure in Mexico City.  The picture is an actual photograph of the museum, although it appears so crisp and stylized as to seem like an artist’s sketch.

This amazing building was constructed by Mr. Carlos Slim, a Lebanese-Mexican businessman, in memory of his wife, Soumaya, who collected many of the artworks in her personal holdings that now reside in the museum.  She was a Mexican, like her husband.  Those artworks, like the museum, were paid for by the family out of their personal wealth.

Lest anyone cringe at the term “Mexican Businessman,” and consider the PRI and institutionalized corruption, this family’s wealth largely derived from introducing the digital age to Mexico and beyond.  One could call him the “Bill Gates of Mexico.”  However, his wealth exceeds that of Mr. Gates, so really Microsoft was founded by the “Carlos Slim of America.”

Of Campesinos that I have met

What we see here in America is largely the campesinos – the rural fieldworkers, who are simply the Okies of the Dust Bowl from a different place, from a different time.

America struggles to understand and handle the presence of illegal Mexicans.  I do not understand why, as they are the model residence in the eyes of government.  They work in an economic paradise, from the government’s perspective.  They often pay Social Security taxes through withholding, using bogus numbers; but they do not collect Social Security earnings, nor Medicare nor Medicaid.  They pay millions, but are not entitled to any benefits – any government’s ideal citizen.

In America, the campesinos do not annoy the government with entitled demands and expectations; they usually hide from any contact with authorities.  They flee.  They cannot argue for their Fourth Amendment rights, or other Bill-of-Rights stuff; that is not their America.

Unlike the farm and orchard, the Mexicans I see come from a broader swath of background and culture than the pickers and stoopers of the Central Valley in California. 

My interest is not in what makes pickers pick – our civilization has spent many millennia gathering food from the earth, and it is not a valuable enterprise, regarding wealth and prosperity.  It will keep you alive; the gleanings of windfall can be eaten from the orchards, the bruised apples and wormy pears.

In actuality, the term “Mexican” can mean picker, or entrepreneur, when applied to the whole spectrum of the country’s people.  Here in the US, we simply mean campesinos, and for some reason fear and despise them.  What Mexicans do to us does not concern me as much as what we are doing to ourselves.

Campesino Medicine

Somehow, the recruiters have gotten my email address.  I am offered a position in Virginia.  “Are you available in December to pick up hospitalist work?  We have a new facility in Virginia looking to fill their schedule and need your help!” And in California: “CA Puzzle Piece Solutions 1Hr to Bay Area, California - $300,000+ Real Potential - 100% Outpatient - No Call.”  Or Las Vegas (NV) “See a show or try your luck in Las Vegas for 6 months!~ ANY State License Gets You Here” And East Coast: “we have an opportunity just minutes form Philly and the Jersey Shore in our rehab facility.”

This is depressing.  How does a former profession go from providing care, to eMigrant labor in the 21^st century?  Of all the business models for healthcare in the future, why the campesino model?

I have no particular contempt for the campesinos from Mexico.  One side of my family came to the factory town of Lawrence, Massachusetts to work in the mills doing handwork; the other side fled north Texas to high water and survival in Magdalena, New Mexico.  I think no less of pieceworkers, or pickers and stoopers; I only ask why that means of producing things is still used beyond Neolithic agriculture.

Of ideas old and discarded.

Somehow, we have harvested the chaff in management planning, at least in medicine.  All of the terrible ideas in management that were energetically discarded years ago have gone underground, and survive still in the HR departments and general occupational consciousness in America.

Early in the Journal of the Harvard Business School, Whiting Williams criticized and scrutinized some of these terrible old ideas and suggested a reformation of them.

To-day the majority of us find ourselves in such contact with the general public that we are likely to accept as final for us-the measurement of the particular tape-line which that public, rather than any smaller and probably more discerning group, currently, employs.   Here in the United States, that is apt to mean the pursuit of one thing - wealth.  For, at the present time at least, the dollar furnishes ·the yardstick by which the great body our fellow citizens habitually endeavors to determine the exact degree of each member’s accomplishment.

…

Too long we have thought of work as a curse. The truth is that every one of us plays a part in making it whatever it is; it becomes a curse only when we withhold from the performer of any useful service our proportionate economic and social recognition. Because we have so long failed to see men's wish for worth through work, we have failed too often to keep our promises of reward. Indeed, we have too generally based our whole program of the management of our industrial personnel less upon the hope of reward than upon the fear of punishment. That fear is the fear of discharge the fear of joblessness and all of those attendant stigmas and miseries which not management but society has erected.[1]

No campesino would speak well of any of the current management ideas.  They would agree with Williams – for what other purpose would drive a family to uproot themselves in the old country and flee to a new land without any guarantee of success, other than the hopes that Williams writes about.

They may be proud of being campesinos – of working hard with dignity.  They are not proud to be campesinos.  Their children are intended to be Americans.  Every culture that has come to America has hoped to make their children Americans, not second-class Americans.  Although they may derive honor for feeding their children, they would be embarrassed if their children only follow in their footsteps.

The awful idea remaining is that if a certain enterprise is considered too expensive, one should fracture it into constituent elements, rote behavior and piecework; and measure the productivity of the “pieces” scientifically, in order to maximize profit and throughput.  Then one can offer “best practices” that maximize the productivity of the workers’ hands.

Nowadays, Williams sounds uncomfortably Euro-socialist, and Frederick Taylor more familiar, at least in the concepts currently used for management in medicine, in his assertion:

As has been pointed out, however, the underlying principles of the management of "initiative and incentive," that is, the underlying philosophy of this management, necessarily leaves the solution of all of these problems in the hands of each individual workman, while the philosophy of scientific management places their solution in the hands of the management… Under scientific management, on the other hand, it becomes the duty and also the pleasure of those who are engaged in the management not only to develop laws to replace rule of thumb, but also to teach impartially all of the workmen who are under them the quickest ways of working.

All that is needed is to include the assumption, in medicine, that management is the thing learned in a business school with an MBA, and that MBA’s should direct the business of medicine, and there you have it – the history of medicine over the last few decades.  Taylor long ago invented “management” as a class of people, as well as a duty; he implicitly accepts the division of the “management” class from the “proletariat,” as Marx sketched out decades before.  The inherent assumption is that those who ‘do’ cannot possibly see the forest for the trees, and it takes a special, remote class to govern the strategic interests of the enterprise.

We have decided that we no longer have the money to pay for medicine, and our response is to revert to Taylorism.  To make it work in America, we must denigrate the status of the ‘do-ers’ to pieceworkers, and the ‘leaders’ as the management class – a concept credible only to Marxists and scientific managers.

In order to dissolve the old model of healthcare, we have needed to disparage the professions, which we have done so admirably with nursing.  Now, it is the doctor’s profession that is being reconstructed as the shifting, migrant pieceworker, here in the Central California valley for a few months, then up to Oregon for a few more – the locum tenens and the campesino as all but the same principle.  As picking strawberries is easily measured and paid, why not the provision of medical care?  From a management perspective, they are all the same.

Where are we going?

 So, we continue to stagnate with management ideas that are a hundred years old and obsolete.  Meanwhile, Latin America is becoming digital.  The Mexican GDP exceeds that of Canada; it rivals and may soon exceed that of the UK and France.  Mexico did not really have a firm foundation for stability until 1929, when it became a stable autarchy of the PRI; it has only recently had a credible multi-party government in this millennium.  Within a much shorter time period of stability, Mexico is rapidly flourishing.

Like the Ottoman Empire and Roman Egypt, America might become the Amusing Old Man of the New World over the next few decades.

Do-ers and leaders.

Somehow, after starting with a powerful contempt towards nobility and class, we have settled into a culture riven with class and status; while Latin America struggles to jettison its old racism and discrimination.  They, like the Americans of old, are becoming more interested in those that can do, make and build, over the old aristocratic days of color and family. Perhaps the legacy of Jefferson and the founders has spread; it has not taken permanent root at home.  We persist in our Puritan certainty of this land as Divinely Chosen even after nothing recognizable persists from those days.

---

[1] A Theory of Industrial Conduct and Leadership, Whiting Williams, Harvard Business Review April 1923
Ref:  See also Chomsky interview on Taylorism, Here.

On the herd animals.

Mahan fiddled with the damp coaster on the scarred table, considering another draft.
Nah, he snarled, and don't think I'm being a softie with the vegetarian and all.  I don't eat the animals because I think humans oughtn' associate with such beasts.  They are dirty, and not in the flesh, but their lives in the herd corrupt human civilization.  We have had such animals and are changing to make us like them, and it is wicked.  They live on instinct, a we on adaptation, and such things as goats are a powerful wicked source for our lives...

On the Compass.

Conversus deinde ab superstitionem, quia ignorantes opera superstitionem crudus est, qui inscriptus est laborum maiores blasphemiam ab his imitando quod non potest comprehendere et exterminantes quod prae manibus est.

Signum ergo “compassum” esse magnam, quae Academia nomen tanta sumsit a machinam.  Similitudine nomen "Al Kompas", et facit aliud con passio, ut quidem Academiae certam ut verius dicuntur. 

Mussulmen enim credebam in orationibus, ipsi vertere quodam modo propheta ad illum locum ubi vixerit vel docuerit.  Apud antiquos enim Mussulmen qui habitabat iuxta Mecca locum qui vocatur, magna nec certamine tantus labor implendum. Quidam ad Meccam futurum oriente ad occidentem, qui habitabat orare, et habitatores Mecca occidentem, orientem petere futurum, et cetera. 
Sed tunc sicut Mussulmen migrare fecit, et ire procul mandatum eorum sustinuit in partem orare, tametsi longe ab domo Prophetae.  Unde coacti sunt, non ex sua sapientia, sed ignorantes ab officio religionis geo maior fieri, ut utra ut accuratius ostendere chartae, ut oraret.
Unum peculiarem simillimum videatur, licet tanta aeternam donare Deum momenti, de Mussulmen erant certa, iussit orare et non solum pro eo, et quidam quidem Deus volebat ire civitati uno tempore in animas eorum.

Didicerunt scientia, et in circino magnetite ergo Mussulmen valde capax eorum geometria et peregrinationes.

Facti sunt non solum ut expeditior in circino, sed peritior cogitationis vias, decursu saeculorum paucis ingeniosi homines animadverterat, quod singulis situm proprium haberet directionem Mecca. Nec circumdabit posse componi ex qualicumque indicant ingeniosa inventione quae semper vera Mecca. Etenim quae tantummodo locum habeat numquid forte fortuna austrinos conditione ville versus ambitum ostendat Mecca.

Ex diebus antiquis in Mussulmen movet tam paradoxum - nam solus, quia ignorans quo Mecca circino erat inanis esset. Sed haec machina non est determinare quonam Mussulman non semper orare. Ita non modo prorsus inutilis est, in definiendis versus ambitum Mecca, sed etiam omnino oportet determinare intendit.

In circulum vertitur in singulis hominibus, verum est Cor Dei. Ubicumque sit, tamen in veritate viam Dei manet in aeternum, an in illo homine, ut quodam percipiant.

Tamen via illa non numquam simpliciter, quia duo non possunt esse simul in eodem loco, et non est idem, non est tarnen ad duos in eadem directione Cor Dei. Aliud enim est unum hominem, alterum sine altero iudicatur, similiter nec unus Deus potest sustinere. Nam aliter unum posset peccatum, quod altera possit iudicari; oboediens aut magno et facere aliquid aliud quam Deus arridet.

Sic non est magis unum hominem quam alterum errorem, quia hoc ipsum quod est Cor Dei, aliud refragantibus, quod alio est Cor Dei. Nam eodem modo terrentur Mussulmen id circumierunt minima erroris occasionem satagerent Mecca versus usque ad os in ordinem desit locus, ita quoque contra omnes homines praeter maculam Cor Dei, ut omnino nusquam scire potest Cor Dei: et ita fallibilia animalia nihil nisi quam humilitas et obsecratio ad salutem petunt suscipit non meritis nostris.
____

Turning, then from superstition; for superstition is only the crude work of the ignorant, which is disrespectfully scrawled upon the works of greater men, by those imitating what they cannot comprehend, and defacing all that comes to hand.

The Compass did become a great symbol of thought, so great that the Academy took its name from that device.   It is said that the similarity between the word "Al-Kompas", and the other word compassion made even more truly the certainty of that Academy that they should be called such.

For the Mussulmen did believe that in their prayers, they were to turn a certain way, towards that place where their Prophet had lived and taught.  For those Mussulmen in early days, living nearby the place called Mecca, the fulfillment of such a command was no great challenge.  Some who lived east of Mecca would turn west to pray; and those who lived west of Mecca, would turn east to pray, and such.  

But then as the Mussulmen did migrate and travel far away, their commandment to pray in that direction endured, notwithstanding their distance from that home of the Prophet.  Therefore, they were forced, not from their duty to wisdom but merely from their ignorant religion, to become great geometers, in order that they might construct maps to show them in which direction they might pray. 
Although it sounds most peculiar that God would endow one place with such eternal importance, the Mussulmen were fixated upon it; for not only were they commanded to pray to that place, they also were certain that God wished them to travel to that City at least one time in their lives.  Naturally, their interest in geometry was practical in this instance, for they needed to know not only the direction of that place, but also the means of travel thereto.  Having been taught the science of magnetite and the compass, therefore, the Mussulmen became much enabled in their geometry and travels.

As they became not only more facile with the compass, but also more skilled in the ways of thought, over the centuries some had noticed that each individual location had its own direction to Mecca.  No compass could be constructed by any sort of ingenious invention which would point true to Mecca.  In fact, only those places which were accidentally north or south of that town did ever possess the fortunate instance that the compass should point in the direction of Mecca.

The Mussulmen of old puzzled over such a paradox – for alone, a compass was worthless for knowing whither Mecca might be.  However, without this device, a Mussulman could not ever determine in what direction he should pray.  Thus, a compass was not only completely useless in determining the direction to Mecca, but also absolutely necessary.

Within each man lies a compass which ever points true to the Heart of God.  Notwithstanding wherever he might be, the path to God remains forever true, whether or not that man can perceive it at a certain instance in time.  

Nevertheless, that path is not ever invariant; for as two things cannot occupy the same space at the same time, without being one identity, nevertheless two persons cannot turn to the Heart of God in the identical direction.  For as one person is different than the other, and is judged independently of the other, no two persons can face God in the same manner.  Otherwise, one person might commit a sin, for which the other might be judged; or one might do a great and god-fearing thing, for which God smiles upon the other.  

Thus, one man may not be in greater error than another, for saying that the Heart of God is exactly this way, and another disagreeing, saying that the Heart of God is in another direction.  For in the same way that the Mussulmen fear – that the tiniest error with a compass while attempting to facing towards Mecca might cause one to face in a direction that far misses the mark; so, too, all humans miss the mark in facing the Heart of God, as we can never know the Heart of God exactly; and being such fallible creatures, we have nothing but humility and prayer to beg for that salvation which we cannot earn on our own merit.

More of the History of Alkonbas

Enim videtur in veritate quod omnia, quae per unusquisque tempus in sua, contendere se atque in suo ad conveniens aeternam formam, conveniens quod formam quisque in suo ordine secundum essentiam utriusque. Fortasse aliqui sunt, ut tempus sit falsus arcus, formae ad quam nullo modo sequitur, quod medium inter autem est et non esse,

Non solum ex ad muniendum educationis teleologia animi temperantia sed etiam dare, ut ipsa suis fidelibus mandat cursum huc atque illuc invitamenta ad reluctari. Pecuarius imperitis re utilitas imperitis super frenum equi est, quod visum finiret, ut non reverteretur a via ex distractione. Miles uero, cum equo utitur comitem et imperandi potestatem esse, quo se feret velit.

Et similiter dicendum est de fine Al-kompas tentatio, cum virtutis et sapientiae fons. Nam in pascua decet tantae eruditionis ac effondere gaudium humani effectus. Sed per viam, quam ripas suscipit ergo hic tantum pauca referre Al-kompas et in magnitudine et occasum.

Legenda casus Al-kompas et infernalis describitur creatura in hoc, praebet superstitioni dependens, ex uno crure quod suspensus est, et quod sibi fornicem cicatrix per aspera saxa, et ut impleatur in eis creaturae causa mortis eius. Ut super saxa, et linivit limus factus cemento quod aer non præteribit inter saxa commorabitur. Etenim eo loco, ne diu se ipsa nocte, et super Crucis signo se abstinuit tactu, de illud nequam spiritu. Post triduum coeperunt aeris foedam referant signati ex arce, in modum odoris ossarii.

Sed etiam malum noctis initio, facta incessanter ab intus signato fornicem longinqua sicco risum quasi saxa maximum moverentur super sese.

Ventus vehemens irruit in tempestate in noctis, lavit ex limo saxa, et ecce! non ibi stetit, quoniam una ingens saxum Hurghada eiusmodi antiquis notus est pater fumus, in quo concurrit per venas sanguine rubrum, et indivisus esset et corpore.

For it seems in truth that all things, each by virtue of their existence in Time, strive independently towards Becoming that which is their eternal and proper form, each in its own turn, depending on the essence of each.  Maybe some thinkers themselves, might have said that Time itself is a false arch, having no form within towards which it thus pursues; but is merely rather the space between which Being and Non-Being, the Perfection and the Nullity, arch.

The end of education is not only to strengthen the mind, but also to give it temperance, that itself may command its faithful direction, resisting the temptation to turn this way and that.  The unskilled drover uses blinders upon the horse, that it may not turn from the path due to distraction.  The knight, on the other hand, uses the power of command and comradeship with the steed, that it shall bear him whither he desires. 

So, too, the temptation is great to speak endlessly of Al-kompas, being a fountainhead of virtue and wisdom.  Indeed, it is fitting to frolic in the pasture of such great learning and human accomplishment.  Rather than creating a path that is only a meander, then, only a few incidents shall be recounted here of Al-kompas and its greatness; and its fall.

The legend of the fall of Al-kompas and that infernal creature herein described, offers the superstition that it was hanged dependent from one leg, and that the arch itself was closed up with rough stones, so as to seal the creature therein and cause its death.  Mud was created and spread upon the stones as a cement, that air not pass between the stones.   For long after that night did people avoid that location, and did make the sign of the Cross upon themselves, that they might be spared the touch of that evil spirit.   After three days, a foul air began to waft from the sealed arch, and did smell of a charnel house.

But even beginning that evil night, there came unceasingly from within the sealed arch a distant dry laughter as though great stones were being moved upon themselves.

And then a great wind came upon the storm at night, and washed the mud from the stones, and behold! there stood instead, a single massive stone, of that type known to the ancients as Hurghada, the ‘Father of Smoke’, wherein blood-red veins ran through it; and it was undivided and solid.

Memoriam Alkonbas

O Alkonbas! O tua pietate! O Contritionem tuam!
Nihil in mundo participatur per fontem scripturae divinae sapientiae!

Alkonbas accidit, tam cito finis bibliothecae, qui in tenebris, et memoriam eius redacta cadunt in mille partes tenebris involutam.

Maurus chorum vulgus quidam dicunt in vinculis, inducti ; flagellabatur, habentem in capite suo arietem cornibus. In superliminari scriptus esset verba "vere mendacium fornicem." Maurus suspensus est robustus funiculum per unum crurem.

Hæc sunt omnes fabulas et superstitiones et ultra. Sed tamen casu dicere nefas est et finis loquitur S. Alkonbas.

Tamen et ipsi locuti sunt casus, qui postea horrore de bibliotheca Alkonbas.
___

O Alkonbas! O thy devotion! 

In thy destruction, nothing is left of that fountainhead of God’s wisdom shared into the world through His scriptures!

The end befell the books of Alkonbas so quickly, that the memories of its fall are shrouded in darkness and fragmented into a thousand fragments of blackness.

Some say that the mob was led by a dancing Moor in chains, and whipped, having the horns of a ram upon his head. At the lintel was carved the words "false arch", and the Moor was hanged from a stout cord by one leg.  All these fables are superstitions, and no more.   But they speak nevertheless of the fall of the Library of Alkonbas and the horror that came thereafter.

Hajj Miriam (2)

In Baetica quodam loco maxime notabilis doctorum hominum coetum plusquam aliis locis in Baetica, ex variis religionibus fidem non inuenit in mundo sunt omnium quae fidei Academia ad discussionem omnibus hominibus.

Nam ita fuisse Athenis antiquitus in Academia et sapientium et doctorum hominum, qui homines studiosa natura disseruit aeterna, ita ut nemo fidem conterere, sed pro quibus ipsa ratio vulgo abhorrens praeter .

Etiam apud infideles, sapientes fuisse rationem dialecticam extulit arma cognita acceptaque de natura Dei. Et quia existimarent quod nullus homo poni ratio ex propositionibus per naturam Dei capere possent, tamen esset officium omnibus exquirentibus se animo et studio divinis possent. Hos paucis alumni  qui persecutus est Academia has quaestiones Alkonbas strenue se vocabant, seu "circuitus".

Nam in scripturis sacris habetur Mussulmen, quod fide crederent per mandatum Dei, ut noveritis eos, qui servant testamentum Abraham, et facere bene in nobis, qui sequebatur Iesus, qui dicitur "Isa" secundum linguam suam.

Magis mirabile est, Mussulmen cognoverunt, quod Deus erudierunt propheta Muhammad simpliciter veritatem, et veritas Dei eorum factus est simpliciter scripta legis et evangelii, in sacris litteris ipso Deo amabiles et sine erroris.

______

In a certain place in Andalusia, most notable for its gatherings of learned men, moreso than other places elsewhere in Andalusia, men of faith of the various religions practiced in the world did found a academy for the discussion of matters of faith that are universal to all men.  

For there existed in ancient times in the Academy of Athens such wise and learned men who could understand and discuss matters of the Eternal, in such a way as to bruise the faith of no men, excepting the unlettered and those for whom reason itself was repellent.  

Even amongst the infidels, there existed men of wisdom who exalted logic and dialectic as instruments of discovery of the nature of God.   They supposed from propositions using logic and reason that although no ordinary man could possibly apprehend the true nature of God, nevertheless it was the duty of all men to seek out the nature of God as eagerly and wholeheartedly as they possibly could.  The small academy of students who pursued these questions energetically called themselves Alkonbas, or “The Compass.”

For in the writings considered to be holy by the Mussulmen, they did believe that the faithful were commanded by God, to respect those who keep the covenant of Abraham, and to respect those who follow Jesus, who is named 'Isa' in their language.

  More amazingly, Mussulmen knew that God had instructed their Prophet Muhammad only the Truth, and the Truth of the Gospel and the Scriptures of the Law of God was holy and were sacred books, and given of God Himself without error.