Took a taxi to the airport and saw the vastness of new Zagreb with endless socialist flats and more being built.
Zagreb airport is tiny. I had beautiful views of the Dalmatian coast with azure blue sea small cluster of red roofed house and long peninsulas. I could also see how rocky the ground was.
I took a taxi to Trebinje, our first town. More beautiful views, first of Dubrovnik and the bay, then of the landscape here, vineyards on the valley floors, small trees, dominated by bare mountains with their lines of sediment visible.
Trebinje is a lovely town which shows off the different styles of Bosnian architecture, there are old Ottoman gates, a bridge , an old town with a mosque, small houses , two churches and then a modern gate that leads into the Austria Hungarian part of the town with larger houses, and cafes around a plane tree filled square. In the evening this was filled with Bosnians with 80s music playing.
I had the afternoon to myself because I arrived ahead of the group. I really appreciated this and wandered around the town by myself enjoying the cafes.
The group arrived about 6.00; 16 of us and we seem a typical Exodus mix with a couple of couples and an abundance of single women. The oldest is a wiry man who lived in Islington all his life and moved out to St Albans and now comes back to London the whole time.
In Trebinje one could also see the socialist style buildings, I found a large medical outpatients and a very light airy modern post office.
Bosnia is visibly poorer than Croatia with poorer quality goods and not such a range, lots of local produce especially water melons.
Nice guide Samir who has been doing this tour for some time.
Surprised to see Cyrillic script on the road signs and hotel.
Tuesday, 15 July 2014
Monday, 14 July 2014
Zagreb: Walking round 19 c buildings, museum of broken relationships, live open air jazz.
I walked all over Zagreb, getting the feel of the town. It has a nice 19 c Austria Hungarian centre, lots of cafes and all the museums were closed on a Monday.
The cathedral is rebuilt neo-gothic , not very exciting, The other church has an amazing tiled roof with the Croatian coat of arms. I enjoyed the coffee and the cafes and bars were full of people meeting and talking. They are quite stylish but not aggressively so. I ended the evening in a fine open air jazz bar terrace and with hundreds of night lights on a wall and easy chairs for sitting. A young woman sang jazz classics accompanied by a key board player. Very relaxed.
I visited the Museum of Broken Relationships which is an extraordinary collection of objects that people have donated to mark the ending of various relationships. Romantic love and betrayal dominated and the objects which ranged from bits of pottery to magazines, a setting of the components of an Amstrad 64 to an axe. All had their stories. Many around the theme of love that initially seemed wonderful but then was not sustained, others of women betrayed by their husbands after decades of marriage, the axe belonged to someone who on being betrayed had chopped the betrayer’s furniture up into small pieces and handed it over. It was a strange sad collection, love is a universal phenomenon, betrayal is common, the stories were touching, sometimes the briefer notes were more poignant, one vase had by it: a business relationship that developed into an amorous one and both failed. In others the anger was still very palpable and the museum perhaps allowed people to dump their anger. I liked the philosophical exploration of the museum and was sad that it did not explore relationships between broken Balkan states for instance.
Interesting if rather mournful way to spend the afternoon
The cathedral is rebuilt neo-gothic , not very exciting, The other church has an amazing tiled roof with the Croatian coat of arms. I enjoyed the coffee and the cafes and bars were full of people meeting and talking. They are quite stylish but not aggressively so. I ended the evening in a fine open air jazz bar terrace and with hundreds of night lights on a wall and easy chairs for sitting. A young woman sang jazz classics accompanied by a key board player. Very relaxed.
I visited the Museum of Broken Relationships which is an extraordinary collection of objects that people have donated to mark the ending of various relationships. Romantic love and betrayal dominated and the objects which ranged from bits of pottery to magazines, a setting of the components of an Amstrad 64 to an axe. All had their stories. Many around the theme of love that initially seemed wonderful but then was not sustained, others of women betrayed by their husbands after decades of marriage, the axe belonged to someone who on being betrayed had chopped the betrayer’s furniture up into small pieces and handed it over. It was a strange sad collection, love is a universal phenomenon, betrayal is common, the stories were touching, sometimes the briefer notes were more poignant, one vase had by it: a business relationship that developed into an amorous one and both failed. In others the anger was still very palpable and the museum perhaps allowed people to dump their anger. I liked the philosophical exploration of the museum and was sad that it did not explore relationships between broken Balkan states for instance.
Interesting if rather mournful way to spend the afternoon
Sunday, 13 July 2014
18 hour train journey Berlin, Prague, Vienna, Zagreb. Interesting, varied and exhausting
Started with a fast taxi ride across Berlin to reach the Berlin Sudkreuz station where I picked up the Prague train. I then found that this was the sleeper from Amsterdam and I slipped into a vacated compartment, stretched out and slept for 3 hours so catching up on my lost sleep from my very early start.
From Prague I was sharing a compartment with a Japanese music critic who lived in Vienna and a family from Montreal: a young couple who had an adopted Chinese girl. They were on their first trip to Europe. We all used our electronic gadgets; the critic was enjoying classical music on his phone and three of us had iPads. The Canadians were visiting friends and had brought caseloads of maple syrup. I enjoyed the very varied forest outside Prague and I remembered the steep and endless hills of Bohemia from cycling there in 1990. I enjoyed getting out at Prague and photographing the station. The scenery after Prague then flattened out into the Danube flood plain with huge wheat fields, all with ripe yellow plants.
I changed trains at an uninspired modern interchange, Vienna does have a huge new hauptbahnhof which looked like Reading station. But the train to Zagreb was elderly and looked as though it had been doing the Vienna Zagreb run for decades. Here I shared a compartment with 3 Americans and 2 Austrians, one a young chiropractor who got down at Graz and a middle aged woman who got down at Leibnitz. The scenery on the Vienna Graz section was breath-taking, we climbed up through forest with Alpine rocks and peaks, mountain cows grazed at impossible angles on the slope. We then had interesting views of rivers and churches in Slovenia.
The Americans were a couple and a young friend who were using all their holiday for a European trip. They were staying in hostels and moving on couple of days. The two men were engineers working on building gas and oil pipe lines and clearly loved their work.
The last two hours to Zagreb were very long and we had our tickets checked endlessly. Very glad to get here and to have a nice hotel to check into. The World Cup final was in the last stages as I arrived but I was too tired to watch but I did later wake up and had to check the score.
From Prague I was sharing a compartment with a Japanese music critic who lived in Vienna and a family from Montreal: a young couple who had an adopted Chinese girl. They were on their first trip to Europe. We all used our electronic gadgets; the critic was enjoying classical music on his phone and three of us had iPads. The Canadians were visiting friends and had brought caseloads of maple syrup. I enjoyed the very varied forest outside Prague and I remembered the steep and endless hills of Bohemia from cycling there in 1990. I enjoyed getting out at Prague and photographing the station. The scenery after Prague then flattened out into the Danube flood plain with huge wheat fields, all with ripe yellow plants.
I changed trains at an uninspired modern interchange, Vienna does have a huge new hauptbahnhof which looked like Reading station. But the train to Zagreb was elderly and looked as though it had been doing the Vienna Zagreb run for decades. Here I shared a compartment with 3 Americans and 2 Austrians, one a young chiropractor who got down at Graz and a middle aged woman who got down at Leibnitz. The scenery on the Vienna Graz section was breath-taking, we climbed up through forest with Alpine rocks and peaks, mountain cows grazed at impossible angles on the slope. We then had interesting views of rivers and churches in Slovenia.
The Americans were a couple and a young friend who were using all their holiday for a European trip. They were staying in hostels and moving on couple of days. The two men were engineers working on building gas and oil pipe lines and clearly loved their work.
The last two hours to Zagreb were very long and we had our tickets checked endlessly. Very glad to get here and to have a nice hotel to check into. The World Cup final was in the last stages as I arrived but I was too tired to watch but I did later wake up and had to check the score.
Wednesday, 28 May 2014
Dutch cousins in Brecon
Showing Welsh caves and mountains to visitors from the flat lands (May 2014)
It was fun having my cousins as visitors to Brecon May 2014, there were three generations, Noor, my cousin aged 69, Willemien (49) her daughter and her children Emma (11) and Martin (8). They flew to Bristol and rented a car, but brought their Dutch speaking Tom-Tom for navigation. Emma and Martin whooped with delight at seeing the mattresses on the floor and the sleeping bags had been organized for them.
We took my mother to Llowes to visit my father's grave followed by a pub lunch in the Radnor Arms. We sat in the summer house and it felt light and Scandinavian with views of the Black Mountains and the green fields and trees of the Wye valley. At the Brecon Beacons centre there were visiting falconers and Emma and Martin were photographed with kestrels and Harris hawks perched on their arms. Martin was bold in his choice of bird but his courage failed him when the fierce bird was perched on his arm.
At the Dan-yr-Ogof caves, we experienced geology in action; we walked deep into the mountain along a path that twists and turns through the active geological processes, there are live stalactites and stalagmites dripping and growing and one sees the force of water on rock in real time. The second cave is called the cathedral because it has vast caverns with deep streams and the so called curtains rock formations are illuminated. It is an extraordinary feeling being so deep inside the mountain and seeing the rocks being moulded. Outside the caves huge dinosaur models prowled on the hillside even though they were dislocated in time and place.
We confined the shopping to a visit to Hay on Sunday where they enjoyed the craft and art shops and the clothes shops. Hay is such a contrast to Brecon; Hay is like Hampstead whereas Brecon is a working county town. I also love showing people around Brecon, there are so many different things there are for them to enjoy.
It was fun having my cousins as visitors to Brecon May 2014, there were three generations, Noor, my cousin aged 69, Willemien (49) her daughter and her children Emma (11) and Martin (8). They flew to Bristol and rented a car, but brought their Dutch speaking Tom-Tom for navigation. Emma and Martin whooped with delight at seeing the mattresses on the floor and the sleeping bags had been organized for them.
We took my mother to Llowes to visit my father's grave followed by a pub lunch in the Radnor Arms. We sat in the summer house and it felt light and Scandinavian with views of the Black Mountains and the green fields and trees of the Wye valley. At the Brecon Beacons centre there were visiting falconers and Emma and Martin were photographed with kestrels and Harris hawks perched on their arms. Martin was bold in his choice of bird but his courage failed him when the fierce bird was perched on his arm.
At the Dan-yr-Ogof caves, we experienced geology in action; we walked deep into the mountain along a path that twists and turns through the active geological processes, there are live stalactites and stalagmites dripping and growing and one sees the force of water on rock in real time. The second cave is called the cathedral because it has vast caverns with deep streams and the so called curtains rock formations are illuminated. It is an extraordinary feeling being so deep inside the mountain and seeing the rocks being moulded. Outside the caves huge dinosaur models prowled on the hillside even though they were dislocated in time and place.
We confined the shopping to a visit to Hay on Sunday where they enjoyed the craft and art shops and the clothes shops. Hay is such a contrast to Brecon; Hay is like Hampstead whereas Brecon is a working county town. I also love showing people around Brecon, there are so many different things there are for them to enjoy.
Thursday, 15 May 2014
Madrid Renaissance palaces and Modern architecture
After teaching in Madrid I dipped into the severity of the Spanish Golden Age and contrasted it with 21 c Madrid house.
I was over in Madrid for a weekend, first teaching on Miguel Gorgolas’ DTMH. The students are brave and cope with lectures in English. Many of them will then go for field work In Ethiopia so it is good practice.
After the teaching I had a day as a tourist with Miguel. We drove out on the Madrid plain to El Escorial which is surrounded by the oak trees, the small Spanish variety where pigs are fattened on acorns. El Escorial is an exceedingly severe building with long symmetrical sixteenth century fronts. They are very flat and severe. Inside we walked around the king’s apartments; I liked the tapestries designed by Goya, these had a humane feeling because they depicted life and events. Royal chamber pots were preserved for us to admire. The kings also had a large room for exercise- a renaissance gym, here they could walk around; the walls were decorated with maps of the known world, all surprisingly accurate, so the kings could muse on their possessions as they exercised. The royal family and its vast entourage also changed palace every 3 months which seemed a ghastly upheaval for everybody. We also descended to a chilly mausoleum where the Hapsburg tombs were displayed. Powerful even in death. I was glad to come out into the sunlight.
In the evening we fast forwarded to the twenty first century. We went to a science evening to promote at the home of a Jewish businessman. He had built a new house in the Madrid 7 years ago. It was ultra- minimalist with white concrete walls. No windows were visible at the front of the building but the back had large windows and a living room that opened out and became part of the garden. The swimming pool was next to the house with Hockney blue water and also appeared to be part of the construction. The house also had modern paintings and sculptures in the garden. We sipped wine, ate nibbles from black slate trays. A young Jewish woman scientist gave a talk about her research on melanoma that she was doing at the Weismann institute in Tel Aviv. She had moved there from doing a PhD and post-doc in the US. She was an excellent ambassador about science and talked clearly and enthusiastically about the work, the molecular biology that underlay it and how she was hoping that it would translate into clinical impact.
I also talked to a Spanish neurobiologist about our work on the pain experienced by leprosy patients. I enjoyed the contrasts of the weekend, It is interesting going to Madrid annually and seeing different aspects of the city.
I was over in Madrid for a weekend, first teaching on Miguel Gorgolas’ DTMH. The students are brave and cope with lectures in English. Many of them will then go for field work In Ethiopia so it is good practice.
After the teaching I had a day as a tourist with Miguel. We drove out on the Madrid plain to El Escorial which is surrounded by the oak trees, the small Spanish variety where pigs are fattened on acorns. El Escorial is an exceedingly severe building with long symmetrical sixteenth century fronts. They are very flat and severe. Inside we walked around the king’s apartments; I liked the tapestries designed by Goya, these had a humane feeling because they depicted life and events. Royal chamber pots were preserved for us to admire. The kings also had a large room for exercise- a renaissance gym, here they could walk around; the walls were decorated with maps of the known world, all surprisingly accurate, so the kings could muse on their possessions as they exercised. The royal family and its vast entourage also changed palace every 3 months which seemed a ghastly upheaval for everybody. We also descended to a chilly mausoleum where the Hapsburg tombs were displayed. Powerful even in death. I was glad to come out into the sunlight.
In the evening we fast forwarded to the twenty first century. We went to a science evening to promote at the home of a Jewish businessman. He had built a new house in the Madrid 7 years ago. It was ultra- minimalist with white concrete walls. No windows were visible at the front of the building but the back had large windows and a living room that opened out and became part of the garden. The swimming pool was next to the house with Hockney blue water and also appeared to be part of the construction. The house also had modern paintings and sculptures in the garden. We sipped wine, ate nibbles from black slate trays. A young Jewish woman scientist gave a talk about her research on melanoma that she was doing at the Weismann institute in Tel Aviv. She had moved there from doing a PhD and post-doc in the US. She was an excellent ambassador about science and talked clearly and enthusiastically about the work, the molecular biology that underlay it and how she was hoping that it would translate into clinical impact.
I also talked to a Spanish neurobiologist about our work on the pain experienced by leprosy patients. I enjoyed the contrasts of the weekend, It is interesting going to Madrid annually and seeing different aspects of the city.
Tuesday, 22 April 2014
Spring in the Yorkshire Dales
Easter walks in The Dales experiencing springtime abundance.
At Easter weekend I walked again with Les and Vera, this time in their own county. We had a fine 5-hour circular walk that took us up over the moor top and then down into the Dales. We started at Arncliffe village and climbed up Old Cote moor. The landscape there is treeless, open and bleak, later on in the summer there will be heather but now the moors are dark brown. On the moor top grouse sped up from their nests squawking away. We then wound down into Wharfedale past an empty grey stone farmhouse. Down in the valley the fields were green and the curves of the river glinted in the sunlight. I was bitterly cold and had to warm my frozen fingers with soup in the pub in Kettlewell. We then climbed up out of the Wharfedale with beautiful views of the horizontal layers of rock sediment laid down millions of years ago. We then descended through Hawkswick moor to the valley. The sun had warmed the valley and it brimmed with spring abundance. The lambs were skipping around but keeping close to their mothers, both lambs and ewes were numbered so we could see when there was ewe-lamb mismatch. Black and white oystercatchers were pecking for grubs in the pasture and sand martins had arrived early and were swooping up and down on the river surface. In the village there were spring flowers in the hedgerows, daffodils, primroses. The contrast between the grey bleakness of the moor top and the warm spring valley was striking. It was like an Alpine descent when one moves into a different vegetation type.
Easter Day (Apr 20) was bright and breezy and we walked on Ilkley moor, again experiencing the vast openness and the greyness of the bracken. Further down the gorse was in flower and giving the view a cheerful yellow aspect. Up here kestrels were hovering and ready for action. The bracken was not yet out and the view was unadorned. My iPhone weather reading was “6 deg feels like 2” that felt accurate. We were home for lunch of salad and cheese shared with Eve and Aleandro. Then I returned to London to be on call on Easter Monday.
It was a fine way to celebrate the spring renewal.
At Easter weekend I walked again with Les and Vera, this time in their own county. We had a fine 5-hour circular walk that took us up over the moor top and then down into the Dales. We started at Arncliffe village and climbed up Old Cote moor. The landscape there is treeless, open and bleak, later on in the summer there will be heather but now the moors are dark brown. On the moor top grouse sped up from their nests squawking away. We then wound down into Wharfedale past an empty grey stone farmhouse. Down in the valley the fields were green and the curves of the river glinted in the sunlight. I was bitterly cold and had to warm my frozen fingers with soup in the pub in Kettlewell. We then climbed up out of the Wharfedale with beautiful views of the horizontal layers of rock sediment laid down millions of years ago. We then descended through Hawkswick moor to the valley. The sun had warmed the valley and it brimmed with spring abundance. The lambs were skipping around but keeping close to their mothers, both lambs and ewes were numbered so we could see when there was ewe-lamb mismatch. Black and white oystercatchers were pecking for grubs in the pasture and sand martins had arrived early and were swooping up and down on the river surface. In the village there were spring flowers in the hedgerows, daffodils, primroses. The contrast between the grey bleakness of the moor top and the warm spring valley was striking. It was like an Alpine descent when one moves into a different vegetation type.
Easter Day (Apr 20) was bright and breezy and we walked on Ilkley moor, again experiencing the vast openness and the greyness of the bracken. Further down the gorse was in flower and giving the view a cheerful yellow aspect. Up here kestrels were hovering and ready for action. The bracken was not yet out and the view was unadorned. My iPhone weather reading was “6 deg feels like 2” that felt accurate. We were home for lunch of salad and cheese shared with Eve and Aleandro. Then I returned to London to be on call on Easter Monday.
It was a fine way to celebrate the spring renewal.
Saturday, 29 March 2014
Team Lockwood at a Leprosy Conference in Le Corbusier’s City. (Mar 2014)
Participating in the IAL meeting in Chandigarh linked into leprosy science and politics and nutured my many friendships.
India has the largest national leprologist meeting so an invitation to speak at the Indian Association of Leprologists (IAL) meeting in Chandigarh, (Mar 2014) was irresistible. I brought my London team, Steve Walker, Saba Lambert (currently in Addis) and David Chandler an MSc student who did a project on the household costs of having ENL, a leprosy complication, in West Bengal. We had to leave our Sudanese colleague Omer Haroun in London because he could not get an Indian visa even though he spent 7 months in Mumbai last year doing new work on neuropathic pain. Team Lockwood stayed in the le Corbusier designed Punjab State Guest house, a 1950s building with a compact design, huge lobbies and mature cedar trees in the garden, we took morning walks by the lake. Our Punjabi hosts organized an excellent conference with talks and excellent open-air parties. The meeting was held in the Postgraduate Institute of Medical Education & Research (PGIMER), one of India’s leading medical institutes where the dermatologists remain committed to the work on leprosy initiated by Bhushan Kumar, a previous head of the department.
The programme included talks from leading Indian leprosy workers including Dr. Vishwa Mohan Katoch, overseas visitors and people working for leprosy in India- NGOs, National and state leprosy programmes. The challenging question of the numbers of leprosy patients in India was mentioned in many talks but more discussion was needed about how to assess the problem now. India achieved “elimination of leprosy as a public health problem in 2005” and this was achieved after patient numbers dropped precipitately between 2003 and 2007. I gave a talk based on my BMJ paper in which I, Vanaja Shetty and Gerson Penna showed that setting targets leads to innovative ways of reducing patient numbers. (1) There was agreement that there is now reduced capacity for diagnosis, highlighted by the talks by Dr. Krishnamurthy and Dr. Sundar Rao.
A new tension is developing because in some districts there will be enhanced case finding which means detecting more cases and this is not compatible with elimination at a district level. I was struck by the presentation of the dermatologist Archana Singal from Delhi who presented data on the numbers of children presenting to her hospital clinic, and showed a significant disability rate in these children indicating that they had been diagnosed late. The Delhi state leprosy officer disputed her data and maintained that there were low levels of children with disabilities in Delhi. The state leprosy officer in Odisha showed that there are districts with high rates, and this is compounded by a huge shortage of trained personnel for the leprosy programme posts. There were two key presenters missing, Dr. Barua from the WHO Leprosy Unit failed to attend, also absent was Dr. Kiran Katoch, she has been closely involved with the Indian national Leprosy sample survey. This was done in 2010 but the results have not yet been published, Dr. Vishwa Mohan Katoch (head of the Indian ICMR) assured us that Parliament would have to discuss the results first. We missed their talks and the opportunity to discuss their findings.
An early morning visit to the Nek Chand sculpture garden was a cultural reward. We were the first visitors and we wandered alone through Chand’s amazing grottos, sculptures and admired his work with figures decorated with glass bangles and abstracts made of old light fittings.
The Punjabis are great partiers and every evening there was an open-air party with abundant booze including Indian style mojitos, food and Punjabis disco dancing. I danced freely and found myself on the conference You Tube next day. When I looked at the clips with my friend Annamma she commented that it must be nice to be so free which is a sad reflection on the trappings of marriage and society.
After the conference I visited Bhushan Kumar and his wife Sarla at home. They have a well appointed house with interesting Indian art and effigies of Hindu gods. Both their children are working in the US, I met their California based IT son with easy openness and an American accent. Bhushan and Sarla retired over 10 years ago but continue to practice. Kumar sees about 10 patients a day in small clinic at the side of his house. It is a real contrast to his days as head of department but also a nice way of using ones medical skills in a low key way.
I was last in Chandigarh 20 years ago and on that visit I then went to visit the Manali valley and drove up to the Rohtang pass. This time I appreciated the lack of traffic in Chandigarh and the organization. I was sorry not to be able to stay on and visit the other le Corbusier buildings.
I travelled to and from Delhi on the fast Shatabdi express. Indian Rail has embraced electronic ticketing and many people showed the travelling ticket inspector their tickets on their smart phones.
I stayed with Jasjit Man Singh in Delhi, she treats me like a daughter welcoming me with green tea even at 3am when I arrived from the London flight and being part of her family enriches my visits. Last time I was there (May 2013) her mother aged 107 was dying; Jasjit had spent years looking after her mother at home. Jasjit is now freer, less sleep deprived and more relaxed, and also on her own spiritual journey. She is an established writer and has written a book about her mother’s life. She writes vividly about her mother‘s early life including a spell as a PhD student in London, marriage to an Army doctor and building an unusual Art Deco house in Haus Khaz. There were family tensions at the end of her life between one son wanting aggressive intervention and others for her to die quietly at home. I suspect that such disagreements are common where ever there are advanced medical facilities.
I left my iPad in Delhi, a disaster because I use it so much professionally. Fortunately I activated my network and within three weeks my iPad had returned to London via Budapest thanks to Leprosy Mission meeting there.
Saba commented on how happy I looked in India, I enjoy being there but it was especially nice having my team there. We all participated in the IAL meeting with different contributions and each took our own lessons from the conference. Many of my professional friends are in the IAL and I enjoyed the warmth of these friendships as well as meeting my close friends .I also met up with many friends and Sujai and Suman Jain from Hyderabad. Sujai was showing photos of his newly adopted daughter aged 6 weeks.
This visit encompassed the politics and science of leprosy, the architecture of Chandigarh and the warmth of friendship.
Lockwood DNJ, Shetty V, Person GO. Hazards of setting targets to eliminate disease: lessons from the leprosy elimination campaign BMJ 2014;348:g1136 doi: 10.1136/bmj.g1136 (Published 7 February 2014)
India has the largest national leprologist meeting so an invitation to speak at the Indian Association of Leprologists (IAL) meeting in Chandigarh, (Mar 2014) was irresistible. I brought my London team, Steve Walker, Saba Lambert (currently in Addis) and David Chandler an MSc student who did a project on the household costs of having ENL, a leprosy complication, in West Bengal. We had to leave our Sudanese colleague Omer Haroun in London because he could not get an Indian visa even though he spent 7 months in Mumbai last year doing new work on neuropathic pain. Team Lockwood stayed in the le Corbusier designed Punjab State Guest house, a 1950s building with a compact design, huge lobbies and mature cedar trees in the garden, we took morning walks by the lake. Our Punjabi hosts organized an excellent conference with talks and excellent open-air parties. The meeting was held in the Postgraduate Institute of Medical Education & Research (PGIMER), one of India’s leading medical institutes where the dermatologists remain committed to the work on leprosy initiated by Bhushan Kumar, a previous head of the department.
The programme included talks from leading Indian leprosy workers including Dr. Vishwa Mohan Katoch, overseas visitors and people working for leprosy in India- NGOs, National and state leprosy programmes. The challenging question of the numbers of leprosy patients in India was mentioned in many talks but more discussion was needed about how to assess the problem now. India achieved “elimination of leprosy as a public health problem in 2005” and this was achieved after patient numbers dropped precipitately between 2003 and 2007. I gave a talk based on my BMJ paper in which I, Vanaja Shetty and Gerson Penna showed that setting targets leads to innovative ways of reducing patient numbers. (1) There was agreement that there is now reduced capacity for diagnosis, highlighted by the talks by Dr. Krishnamurthy and Dr. Sundar Rao.
A new tension is developing because in some districts there will be enhanced case finding which means detecting more cases and this is not compatible with elimination at a district level. I was struck by the presentation of the dermatologist Archana Singal from Delhi who presented data on the numbers of children presenting to her hospital clinic, and showed a significant disability rate in these children indicating that they had been diagnosed late. The Delhi state leprosy officer disputed her data and maintained that there were low levels of children with disabilities in Delhi. The state leprosy officer in Odisha showed that there are districts with high rates, and this is compounded by a huge shortage of trained personnel for the leprosy programme posts. There were two key presenters missing, Dr. Barua from the WHO Leprosy Unit failed to attend, also absent was Dr. Kiran Katoch, she has been closely involved with the Indian national Leprosy sample survey. This was done in 2010 but the results have not yet been published, Dr. Vishwa Mohan Katoch (head of the Indian ICMR) assured us that Parliament would have to discuss the results first. We missed their talks and the opportunity to discuss their findings.
An early morning visit to the Nek Chand sculpture garden was a cultural reward. We were the first visitors and we wandered alone through Chand’s amazing grottos, sculptures and admired his work with figures decorated with glass bangles and abstracts made of old light fittings.
The Punjabis are great partiers and every evening there was an open-air party with abundant booze including Indian style mojitos, food and Punjabis disco dancing. I danced freely and found myself on the conference You Tube next day. When I looked at the clips with my friend Annamma she commented that it must be nice to be so free which is a sad reflection on the trappings of marriage and society.
After the conference I visited Bhushan Kumar and his wife Sarla at home. They have a well appointed house with interesting Indian art and effigies of Hindu gods. Both their children are working in the US, I met their California based IT son with easy openness and an American accent. Bhushan and Sarla retired over 10 years ago but continue to practice. Kumar sees about 10 patients a day in small clinic at the side of his house. It is a real contrast to his days as head of department but also a nice way of using ones medical skills in a low key way.
I was last in Chandigarh 20 years ago and on that visit I then went to visit the Manali valley and drove up to the Rohtang pass. This time I appreciated the lack of traffic in Chandigarh and the organization. I was sorry not to be able to stay on and visit the other le Corbusier buildings.
I travelled to and from Delhi on the fast Shatabdi express. Indian Rail has embraced electronic ticketing and many people showed the travelling ticket inspector their tickets on their smart phones.
I stayed with Jasjit Man Singh in Delhi, she treats me like a daughter welcoming me with green tea even at 3am when I arrived from the London flight and being part of her family enriches my visits. Last time I was there (May 2013) her mother aged 107 was dying; Jasjit had spent years looking after her mother at home. Jasjit is now freer, less sleep deprived and more relaxed, and also on her own spiritual journey. She is an established writer and has written a book about her mother’s life. She writes vividly about her mother‘s early life including a spell as a PhD student in London, marriage to an Army doctor and building an unusual Art Deco house in Haus Khaz. There were family tensions at the end of her life between one son wanting aggressive intervention and others for her to die quietly at home. I suspect that such disagreements are common where ever there are advanced medical facilities.
I left my iPad in Delhi, a disaster because I use it so much professionally. Fortunately I activated my network and within three weeks my iPad had returned to London via Budapest thanks to Leprosy Mission meeting there.
Saba commented on how happy I looked in India, I enjoy being there but it was especially nice having my team there. We all participated in the IAL meeting with different contributions and each took our own lessons from the conference. Many of my professional friends are in the IAL and I enjoyed the warmth of these friendships as well as meeting my close friends .I also met up with many friends and Sujai and Suman Jain from Hyderabad. Sujai was showing photos of his newly adopted daughter aged 6 weeks.
This visit encompassed the politics and science of leprosy, the architecture of Chandigarh and the warmth of friendship.
Lockwood DNJ, Shetty V, Person GO. Hazards of setting targets to eliminate disease: lessons from the leprosy elimination campaign BMJ 2014;348:g1136 doi: 10.1136/bmj.g1136 (Published 7 February 2014)
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