Capital Ring 8 Osterley Lock to Hanwell June 2018

We walked here on the hottest day of the year and were delighted by the English landscape, with birds and abundant summer plants and a cricket match at the end of the day. A hot day with temperatures hitting 24. I was late meeting Robert and Helen at the Boston Manor tube station start because the Piccadilly Line was crowded with travellers for Heathrow. They gave me a beautifully chosen birthday prezzie of a novel about a river by Ester Kinsky. We retraced our steps to the Grand Union canal, a heron perched a large weir. Coots, swans and ducks swam on the canal. There were many canal boats with flower and even solar panels on their roofs. Elthorn Waterside is grassed in now and we would see small trees there. We walked along to the Hanwell flight of locks. Our path tracked the river Brent for the rest of the day. The undergrowth next to the river was abundant and looked like Middle Earth. The huge beautiful Wharnecliffe viaduct built by Brunel in 1838 dominates the valley. The small bricks used in construction reminded Robert and I of N India Moghul architecture. We had excellent ice cream in Hanwell close to the church. A maze, set up to celebrate the Millenium is still growing. Bitterns field, a huge open a wild meadow only mown once a year had with gentle afternoon light on it. Perivale park contained several local cricket matches were taking place with British Indian teams. The Wembley dome dominated the horizon. Crossing the busy, busy A40 on a footbridge, was a low point of the walk. I enjoyed seeing Ealing hospital, where I worked in 1986. Then I used to take the Tube to Boston Manor and bike to the hospital. Our last 2 miles were on tarmac through 1950’s suburbia and we enjoyed seeing the roses in bloom. We ended the day with beer and crisps in a large pub next to the railway station. Highlights had been the Brunel viaduct and it was surprising how english the walk was. We came home by the central line. I have never been this far out on the central line. Danny Dorling wrote a fine small book imaging the people who might live at each stop on the central line. As a social geographer the book had a broad scope. good: Brunel viaduct, ice-cream in Hanwell Bad: journey out to Boston Manor surprising: luxuriant over growth by the paths References “River” by Esther Kinsky 2017 “The 32 Stops”, Danny Dorling Penguin 2013

Baton Rouge: US Hansen’s patients, Southern Hospitality, Mar 2019

I visited the US National Hansen’s Disease service, United States of America in March 2019. I enjoyed seeing patients there and interacting with the physicians and researchers. I enjoyed Cajun food and Southern hospitality. Barbara Stryjewska and John Prestigiacomo are the United States Hansen’s Disease physicians in the national centre in Baton Rouge and we discussed their patients. Many came from Costa Rica, Micronesia. Marshall Islands, and Mexico. They genotype the leprosy mycobacterial strains infecting the patients. One patient from Mexico had both M. leprae and M. lepromatosis infection and was experiencing typical leprosy. I lectured on my work describing my voyage into leprosy with my research and clinical work. I aimed to improve patient outcomes. My map showing the UK patients coming from 34 different countries was admired. I talked about using single monthly doses of Rifampicin, Oxfloxacin and Minocycline as treatment. Barbara took me to Houmas house, an old plantation house, with southern elegance and fine gardens. The evening light was beautiful on the azaleas. We walked around the grounds. Then had interesting cocktails with gin, lime juice and Prosecco in the elegant bar. We shared crab claws and shrimps and I had shrimps on aubergine. Barbara left Poland in 1988, came to the US and retrained. She is a thoughtful clinician and worries about the patients and the adverse effects they experience from the steroid drugs needed to treat leprosy reactions The next day we talked and saw videos of American patients who had acquired their leprosy in the USA. This is due to infections carried by armadillos. One seventy three yr old man was diagnosed late after presenting with a Borderline Lepromatous reaction with oedema and pain and it took him months to be diagnosed, not surprisingly no-one suspected leprosy. He was diagnosed when a skin biopsy was done to investigate his unusual skin rash. A woman from Oregon developed leprosy after a visit to Louisiana 20 yrs ago, maybe having encountered armadillos in Louisiana. Probably many people are infected with M leprae after encountering armadillos but only a few develop disease. The videos of patients are great teaching tools. We lunched in a local cafe, deep fried oysters as a starter then catfish with rice and were given with a discount for us being in US forces through working for the USNHD. The big cities of Los Angeles, Chicago, New York and Miami have the highest numbers of leprosy patients with many patients with reactions, like the patients in my clinic in London. I hope they will start using the Enlist Severity Score in the USA, we developed this as a tool for monitoring disease severity. The social worker was interested in the New Face for leprosy and some patients there might participate. I shared the Lancet New Face article with some of the patients here, Pedro and Dante who were interested in the project. In the afternoon we drove downtown and scrambled up onto the levee next to a full Mississippi. We had supper of sushi on an open air terrace with a beautiful view of the river. Tugboats were plying up and down the river. We were close to a huge bridge with boats moored, a destroyer and a river boat. The sun set and the river went many shades of blue. It was a beautiful moment. Working for the US government gives them safety but many restrictions. They attend few conferences, and these have to be approved. The next morning, I meet with Linda Adam’s group of scientists at the Louisiana State University. They are working on armadillo models of neuropathy, doing drug testing for leprosy in the nude mouse model, and doing M .leprae strain typing, there are armadillo associated strains which are passed between humans as well. M lepromatosis, causes many cases and all types of leprosy in Brazil. I saw the armadillos, pairs of brothers living in cages. They beat their feet against the cages, a sad sound. I enjoyed these days in Baton Rouge, seeing patients in the USA, and the armadillos are transmission of leprosy here. I enjoyed talking to the small group of leprosy scientists here and appreciated the evening beauty of the Mississippi. Sadly John died of Covid in September 2020. He is one of the few people I know to have died. He was very devoted to his Hansen’s patients. He also had diabetes.

Carville – unique history of leprosy and a Louisiana leprosarium March 2019

Carville is an important museum located in the first state run leprosarium in the USA. I visited it with Deanna Hagge after seeing contemporary leprosy patients in the USA Hansen’s Disease service in Baton Rouge. It is on the banks of the Mississippi in cotton growing countryside. I first visited Carville in 2005 when there were still a couple of elderly leprosy patient living there. The bright southern light lit the long corridors, and I imagined the patients who had lived there. My memories were strengthened by photos of that visit in my London clinic. Now the site is a museum and captures the life and the history of Carville, Louisiana with patient stories. There were leprosy cases in the Southern USA at the end of the 19 century who needed treatment, so an institution was established for them, initially run by Catholic nuns, the “Sisters of charity”. In 1917 the institution became a state institution and later a federal one. There is an introductory video on leprosy with the commentary by David Scollard (former Head US of Hansens Diseases Service). The display captured the ingenious adaptations patients made to help their lives including special wheelchairs. The studies on developing an effective treatment for leprosy where done here, promin, an early injectable leprosy antibiotic in the 1940’s. Racism was present with segregation of black and white patients, requiring duplication of everything for staff or patents. Black patients experienced doubling of stigma. The changing governance of leprosy at Carville, as a US government institution was shown in posters. The role of the sisters of charity who initially ran the leprosarium was beautifully explored in documents and posters. “The Star”, a leprosy patient lead publication was written and produced here and they have all the copies. It was an important patient voice and I explored patient stories. The role that veterans played was discussed as patients and advocates. Surprisingly there is no information about where the patients came from and where they had acquired their leprosy. I am interested in this because in London, UK I have seen patients from 34 different counties. Contemporary leprosy with current treatments as recommended by the World Heath Organisation and provide free to government leprosy programmes everywhere was explained. I featured in posters I made with Sandy Patience in 1996 (funded by Lepra) in the media section. Patients were given a number and often took aliases on entering the institution. Inmates escaped to get drunk, have sex and gamble and could then be imprisoned. The need to escape to do these activities gives it a uniquely American perspective. Mardi gras is important In Louisiana and they celebrated other festivals such as Halloween. They played football and golf and the other local teams had to come and play in Carville, occasionally the Carville teams won. The museum concluded with information about contemporary leprosaria with posters on treatment and biology. The work on the museum has been done by Elizabeth Schnieder, a historian. We drove round the institution, stopping at the infirmary and the cemetery, with 400 US military style gravestones. The museum was rich in detail and I hope I can visit again.

Whitney plantation; stories of slavery 2019

an outstanding slavery plantation museum and fish supper in the Mississippi Delta Deanna and I drove out to the Whitney plantation museum where slave narratives, fact and experience are combined. The slave trade is documented with posters and the pope sanctioned the slave trade in 1474. The discovery of America opened up the possibilities for the slave trade. The narrative started with the forts in Ghana where the slaves transitted. The middle passage and slave auctions were shown There were hundreds of slaves on each plantation The degradation of being a female slave, the violence towards slaves, the civil war, the poverty of selves after emancipation were explored. The plantations neede free labour to run economically. Slave narratives had been captured by the federally organised writers programme in 1936. We were given a slave to identify with, I was a young girl. Our site guide was a young black woman with peroxide blonde hair and saw the Baptist chapel the centre of the plantation. We visited slave quarters and experienced the sugar refining process. We walked round the cramped kitchen. The owners lived in opulence with a two storey house and a walking area at the back. The plantation went down to the Mississippi river. The plantation owner was a childless woman who adopted a child. The slaves were dehumanised by being given just one name. Many babies died with malnutrition. There were two memorials, one to the lost children. The other one comprised pieces of black stone with lists of slave names interspersed with their stories and photos, a beautiful and moving memorial. Some of black women were photographed there. Deanna and I sat and absorbed the stories and experiencing the emotions they generated. The museum is very popular, with many guided tours. Deanna was moved and thought that all Louisiana children would understand their history better after visiting. It was one of the best museums I have visited with the powerful combination of stories and photos. I was glad to have read books about the slave trade,1 the underground railway2 and David Olusoga’s book, a about black Britons and seen the films “12 years a slave “and “Djano Unchained”. I have thought of the museum often since the Black Lives Matter movement emerged in the USA. It is an important part of USA history. The past French colonisation of Louisiana is seen in the Catholic churches there. We explored the cemetery with tombs with many French names. We drove up and by the levee and across the Mississippi, with amazing views. The flat landscape reminds me of Holland, with fertile agricultural land. We had supper in a local fish place, sharing a large bowl of boiled shrimps, potatoes and mushrooms with spicy Cajun flavours. I need to practise peeling prawns. We had coffee and beignets, a New Orleans sweet at a branch of cafe du monde. I enjoyed being with Deanna, we share an international perspective and being single women. She enjoys to sharing her local knowledge on people’s lives. It was an excellent day. The museum is one of the best history ones I have visited. I enjoyed eating local food. 1. Rough Crossings: Britain, the Slaves and the American Revolution Simon Schama, BBC Books 2005 2. Black and British. A Forgotten History. David Olusoga Macmillan 2016 3. The Underground Railroad. Colson Whitehead Doubleday 2016

New Orleans 2019

Jazz and meals, Antoine’s, Louisiana. Exhib, preservation hall jazz, snug habor jazz. I had Sunday brunch at the jazz restaurant Antonine’s and my friend Tom Gillis’s brother played in the band there. I mentioned this to the maitre d’hotel and was given an excellent seat in the room where I watched them play. Antoine’s oozes 150 years of restaurant history. A photo of a young Bill Clinton was next to seat. There were many New Orleans folk having brunch. The jazz was easy. I ate oysters and had glass of Buck’s Fizz. I chatted to Tom’s brother and photographed him and his group in the bar. In Jackson square and saw an excellent exhibition about Hurricane Katrina and the local response. The exhibition had an impressive collage of voices and responses. One experienced the storm and the horror of the aftermath. the gap in emergency service provision, became very clear. The national guard should respond to flood damage but they lacked leadership and were unable to do so. The disaster itself was on film the responses and the people crowding into the super bowl for shelter. I remember seeing pictures of those people. Docs at the Charity hospital responded and were then vilified. Maybe the lack of response is linked to the absence of a national health service and fragmentation. Survivors stories were told, one guy returning said his memories of 30 years of playing jazz with people kept him going and could not be taken away. A video installation of different people speaking about being New Orleaner ended the exhibition. There was excellent explanation of why the levels were damaged and the different modes of water damage. V interesting and reminiscent of Holland. My grandfather, a water engineer would have appreciated the display. I enjoyed excellent exhibition about the many forms Mardi Gras in NO and Louisiana, it is a remnant of Catholicism. I had not appreciated how formal the Mardi Gras is. I experienced being atop a float in a video installation. I knew more about Louisiana culture after this museum visit. I queued for the Preservation Hall band show at 18.00., I sat inside and enjoyed a 6 piece band playing Dixieland jazz, 2 trumpeters, drums, guitar and playing regular favourites. I walked across the French quarter to a bar called Snug Harbor to hear an excellent group play modern jazz, the highlight of the day. I joined a small walking tour of the French Quarter(FQ), by a retired academic. We walked down to the river and looked out over the river front. In the FQ we looked at the original houses with had 4 doors. We examined later houses and the iron work. We looked at Tennessee William’s house. We saw the houses associated with the slave trade, and with a fire, that started from a shrine to the BVM. Yellow fever was common until the 20c and it’s cause unknown. Nobody wanted to hire the new men off the ships cos they were a high risk of dying so men hoped for a mild illness then they could be hired. It was an excellent tour and gave me a good over view of the FQ. I had a Louisiana lunch of shrimps and rice in a large cafe with open doors. Then browsed the shops round Jackson Sq. wandered back to my hotel and went to the airport early by taxi. I had an anxious flight to Atlanta cos a storm had delayed our flight. I had 40 mins to spare and ran across the airport, just catching the flight.

Capital Ring 12 Highgate to Stoke Newington

Diana's Year 2019

A busy and fulfilling year; with retirement parties, doing the Trans-Siberian rail journey, coping with Brexit politics, attending People’s Vote marches and now the general election. I launched the New Face for Leprosy project in Ethiopia and globally. Being in Wales for the Hay book festival was a cultural highpoint.  I have enjoyed theatre, music and arts. My community gardening project to improve Union Square is developing. 

I retired at the end of June having worked in the NHS for 38 years. I was the leprosy consultant at the Hosp Trop Disease for 25 years. Some of my patients have been under my care for the whole time. I worked as a consultant in Infectious diseases for the first 21 years in the UCLH team and was given a UCLH long service award in May, the celebration reflected of the diversity of the institute with staff from across the globe and doing jobs ranging from surgery to lab testing to nursing. My leaving party in July was organised by my colleagues. People whom I had worked with and mentored gave short talks that covered my work in leishmania, leprosy, Evidence based medicine, Leprosy Review and my battles with WHO over leprosy policy. David Scollard sent a video from the US on our collaboration. About 100 people came, including patients, family and friends. I was given a unique pair of earrings that have HTD logo one side and LSHTM logo on the other. These were commissioned by a Canadian jeweller by my colleagues.  A jazz band run by a friend of mine played whilst we were eating and drinking. It was a warm affirming event.  Handing over the work has been much easier because I have an excellent successor, Steve Walker who has worked with me for years and is the first black consultant at HTD.  He lead the party organisation team.

I started my retirement with a month in Russia with a week on a Political Tours course and then travelling the Trans Siberian railway trip from Vladivostok to Moscow. Political Tours are organized by journalists to see all aspects of a country. Ours was lead by Russian journalist Leonid Ragozin.  We met people across the political spectrum in Yekaterinaburg and Moscow especially political activists (Vladimir Milov), the human rights problem in Russia and the need for an opposition was palpable from these conversations. Putin has increased wealth for average Russian and the country is visibly improving, but he has rewarded his cronies and prevents the opposition functioning.

Three friends (Rita Krishna, Vincent Stops, Ann Munn) joined me in Moscow and we flew to Vladivostock in Far East Russia and crossed Siberia by train, 9, 2230 km over 14 days, 7 trains.  We had stops in Khabarovsk, Ulan Ude, Listvyanka, on Lake Baikal and Novosibirsk and Tomsk and explored different parts of Siberia. I wrote about each stop on my blog.

The Russian trains are well designed for travel, with 4 bed couchettes and plentiful hot water from the carriage hot water heater for making tea and coffee. The train travels smoothly at 50 km/hr, we appreciated the scenery and explored stations and their food on stops. Russian city architecture is varied with many 19 century buildings and museums,  Lenin statues remain in many central squares. The stations are attractive and well maintained.  We saw much forest but also big rivers and the huge, 220 km long Lake Baikal. Siberian culture with smoked fish, birch bark goods and pine nuts are everywhere. Rita organised the trains in London. Rita spoke some Russian, much needed since few people outside Moscow speak English.  It was a great adventure, I loved the vastness of the country, I found the culture fascinating and I enjoyed the fish meals. I would be happy to return and explore different parts.

 My project “New Face for Leprosy has been exciting. When new leprosy patients go on the net they see pictures of people with severe disabilities, not that it is a curable disease. I started a project taking pictures of treated people working and enjoying life and with messages of hope. We photographed in Ethiopia in Sept 2018 and published in The Lancet on World Leprosy day 2019. Saba and I presented the pictures to Ethiopians affected by leprosy in Gondar. One woman said “ We look beautiful”.  We have taken this positive message to meetings, notably the International Leprosy Conference in Manila in September and patients were excited by this new approach.  I have spent two weeks in India with a photographer Tom Bradley. We were hosted by Lepra India and had a fascinating time hearing about the stigma people experience and how they overcome it.  I met a tabla player whom I treated 30 years ago in Dhoolpet, he played his tabla in a reprise. We plan an exhibition in 2020 and I shall do this work elsewhere.

The political events have been time consuming and depressing.  I was on the People’s Vote march in Oct when parliament voted against Brexit. Jeremy’s Corbyn’s failure to take a remain position was disastrous for reconsidering Brexit and allows the message of “Get Brexit Done” to triumph. Boris despite his manifest failures is PM again. The election results are profpundly depressing. I think we are now in for an extreme right wing politics staring with Brexit. Extinction Rebellion is exciting and their message and approach is hopeful in this dark time.

I have seen many good plays this year, highlights include a female Dr Faustus at The Globe, Rosmerholm with a flood covering the stage at the end. Seeing Pinter plays at the new Pinter theatre remind me of his powerful writing. The Don Mullin photos were a powerful documentation of his work in photographing many conflicts. The drawings of Kathe Kolwitz  at the BM documented the pain of loss. Far East prisoners of war used art to survive imprisonment in a Liverpool exhibition, Secret Art of Survival.  I was deeply touched because my mother was a Japanese PoW and I mused  about her survival strategy.  “Sorry we missed you” is a contemporary film by Ken Loach that captures the destruction that low wage jobs in delivery companies wreaks on families.

My retirement plans include more work on the New face project, also writing a book about leprosy based on patient stories. I shall teach on leprosy. I look forward to more time for photography, travel, gardening, time with friends and family and in Brecon.

Enjoy the Solstice and may 2020 be a good year.