If you have stopped to read this post, the chances are that you know what BNF stands for which means that you might be a doctor, nurse, pharmacist or some sort of health-care practitioner. I have an old dog-eared 2011 edition of The British National Formulary which is the definitive British publication providing information on the use and prescription of medicines. For a medical doctor living in the middle-of-nowhere in Belize, this book is an essential. If you are able to send me a later edition please email me at dra.tsang@gmail.com. Your help would be very much appreciated!
Whenever a patient comes to me complaining of symptoms including insomnia, agitation, headaches, palpations and/or poor concentration the first thing I advise them to do is to stop caffeine for a trial period. I usually get a strange look because I am not reaching out for prescription pad to offer a “quick fix.” Yes I am a doctor who uses empirical evidence to gather data in order to determine whether habits may be causing health problems. I am not just a “one trick pony.” I would like to explain to you my interesting observations on and off caffeine (tea or coffee). The purpose of this anecdote is not to persuade you that what I say is true. But rather to persuade you to test what I have to say.
We have been opportunistically observing ourselves, patients and people in general whilst on coffee. It is interesting to see people very “speeded up” with rapid speech and hand gesticulations just after one cup of coffee…and having absolutely no insight into this behaviour. In fact most people just think that it is part of their personality and will make statements like, “I can’t keep still…I am just that personality type.”
Well let me tell you about my personal observations of on and off coffee. It is very interesting how this actually happened. Like any Scottish person, I like a good cup of tea in the morning and so I have over years, just got into this habit. Anyway, for a change, we decided to drink these novelty “coffee sachets” bought from the Chinese store.
Coffee Sachets.
After about a week, we realised that we were not feeling the usual effects of a cup of tea; these included immediate up-lifting of mood, loquaciousness, occasional palpitations and the general feeling of “needing to get things done…NOW!!” This is when we realised that these coffee sachets probably didn’t contain real coffee (ie.caffeine) and were made up of chicory or some cheap alternative. That made us laugh and we started calling these sachets “Coffee For Kids” as a joke!
Anyway, we continued on our “Kid’s Coffee” for another 3 weeks. Yesterday I decided that it would just be nice to have a good cup of tea to hit the spot. In fact I had two cups of tea back to back. This is what I observed: I felt the sudden urge to move about and do things…wash dishes, do laundry, pack soap and label and do everything all at once. This doesn’t sound too bad but I felt that all these “needs” became a huge pressure in my head and then manifested as palpitations in my chest. It came as a surprise to me that I did recognise these symptoms…it was how I always felt after a cup of tea or coffee. Previously, I had attributed these feelings to my circumstances (pressures of farm work and business, etc, etc). No, it is actually just the physical effects of caffeine…wow, what a revelation. As a consequence to this, I was on my feet until about 5pm before I settled myself down. I noticed poor concentration and lack of focus. Caffeine seems to be good for repetitive “brainless” tasks so in some respects can be useful. I also could not get to sleep which is unusual for me.
Interesting…
Maybe some of us are actually operating at a sub-optimal level from the negative effects of caffeine?
In summary, I think that caffeine (coffee or tea) can be useful in many circumstances which include long hours of repetitive work requiring little concentration. It is also good as a “social tool” because it makes you more talkative. If you are physically and mentally tired, caffeine can certainly perk you up; if your energy levels are fine then you can experience anxiety and agitation as negative effects. Like everything in life, it should be used with awareness of the tasks at hand. In other words, do not use it as a habit and a matter of course. I have written this post in the hope that some people may find these observations interesting and try to test these ideas for themselves. In doing so, it may give people more understanding of control, awareness and self.
Here’s a medical one. An eponymous syndrome is an ailment named after a person. During medical school, it was a favourite past time amongst us all (yes, we were a bunch of sad buggers with no mates) to memorise as many eponymous syndromes as possible and rhyme them off whilst intoxicated with alcohol. Of course, I didn’t do that kind of thing (Ha-Ha) but I did study up on the syndromes like a swotty Munchkin.
Ulysses Syndrome comes to mind because it is rather the way that I have seen Medicine being utilised everywhere.
And so the Ulysses (Odysseus) story and syndrome goes like this…
After the Trojan war Ulysses, King of Ithaca, had many dangerous and perhaps pointless adventures before he returned to his starting place. Similarly, many patients with incurable diseases start with a problem and end up with much the same problem. This is usually after many dangerous and pointless tests. The Ulysses Syndrome describes this over-investigation.
To investigate or not to investigate. Before you embark on your adventure you may want to speak to us about it.
A big Thank-you to Dr. Anna Arzu for providing us with white turmeric! A while back, Dr. Arzu had written an article in The Toledo Howler (a Belize Tourism newspaper based in this district) on this particular aromatic root. After reading it, we had been anxious to procure a specimen to grow on our farm. Last week, we fortuitously bumped into the author of this article and she was happy to provide us with the rhizome. Her gardener, on that very day was cleaning up a bunch of these plants and she said that she had plenty to spare. We raced on down to her house in record time and managed to get our specimen.
White Turmeric Plant.
The Latin name for this plant is Curcuma zedoaria; it is also known as white turmeric, zedoary root, arura and angostura. The last name made us very curious about whether this plant had any connection with Angostura Bitters and so we did some Internet research. Angostura bitters is so-called because it first originated from the town of Angostura in Venezuela and apparently does not contain any flavourings from Angostura trifoliata, a medicinal plant from South America. Our research did not yield any possible connections between this plant and the famous bitters and there is no way of knowing whether this root is an actual ingredient as this is a very closely guarded secret.
Zedoary Root.
We tasted some of the raw root which had camphor-like flavouring with a mild and pleasant bitterness. We have been making tea infusions and I even flavoured a meal with it today. We love this stuff! We have already got it in the ground.
People sometimes ask us what kind of green vegetables we grow on the farm to eat. This is mainly because, as doctors, we are always advising people to eat green, leafy vegetables for their high vitamin and mineral content which helps maintain healthy growth of cells and promotes healing. These people in turn, go to Punta Gorda market to look for them, only to find one common type of leafy vegetable to eat which is calalloo (Amaranth sp.).
Wild Calaloo.
This is fine to eat (though they still complain about the lack of variety) but also they are not found in such great abundance that they can be eaten in substantial proportions everyday. We eat about 100 to 200 grams (1/4 to 1/2 lb) of dried leafy green vegetable a day and this is the amount that we recommend to other people to eat.
Here in Belize, there is a plethora of greens that can be easily grown with the minimum of fuss and maintenance. You just need to regularly harvest (cut back) to stimulate growth and you will have them mostly all year round. The only time there might be a problem is the 2 months of dry season but this can be overcome with daily irrigation which should be possible for a small garden.
We Collect Fresh Greens Everyday.
Malabar spinach is a climbing vine. It grows really well in wet areas. You eat the leafy parts and discard most of the fibrous stem. It can be eaten raw in salads, steamed or stir-fried.
Malabar Spinach.
Chaya plants, also known as tree spinach, needs little maintenance and even survive through drought without much irrigation. They are best chopped finely and boiled for about 20 to 30 minutes.
Chaya.
A more familiar green for people from temperate countries is kale. They need a little bit more care and raised bedding; nonetheless, they can still be cultivated in the Tropics.
Kale.
This one is called Avuvo, apparently a well-known Nigerian green. The seed was given to us by somebody who had plans to grow Nigerian vegetables in Belize for an export market in the States. It grows prolifically.
Avuvo.
Ok, guys go forth and start your own garden of fresh green leafy vegetables! You will find that they taste so much better than the bought stuff! As well as providing ingredients for a healthy diet, maintaining a garden will keep you fit (c’mon …don’t hire a gardener!) and you can save money on your grocery bill.
Hello everyone!! It has been raining all day today so thankfully, our rain water shortage has been temporarily solved. The rainwater tank is almost half full and we have another full tank as back-up. Phew!! We are so pleased!!
Anyway, onto the subject of chili peppers…yesterday, was town day and it was a hectic run-around of seeing patients for the whole morning, meeting up with people for lunch and the usual in-between hailing of passerbys and acquaintances. Not to mention, the rushing around for supplies in between a packed day. By the time I got home at 4pm, I was exhausted. At this point, I started feeling lethargic and then it got worse because I started feeling sorry for myself. One thing led to another and I developed a headache, sore throat and a low-grade fever. I immediately recognised it as the beginnings of the ‘flu (or some sort of viral infection). Gnome knew there was a problem when I reached over to the computer to write a Blog post and I simply couldn’t even muster up the energy to type out the WordPress address. Gnome admonished me gently for being such an awful patient and told me to have a teaspoon of chili sauce, in a drink immediately.
Munchkin Sick and Feeling Sorry for Herself!
I happened to have a glass of beer in front of me (therapeutic dosage to warm myself up of course…honest) so I stirred in a teaspoon of chili sauce and downed it. As soon as I drunk it, it really hit the spot and the I felt an immediate release in my sinuses and head. I felt so much better.
Gnome’s Medical Prescription: Beer
Beer.
And one teaspoon of Chili sauce:
Red Bird Chili.
Culpeper describes this experience very nicely:
“…will so pierce the brain by flying up into the head through the nostrils, as to produce violent sneezings, and draw down abundance of thin rheum, forcing tears from the eyes…”
I went to bed soon after this, feeling nice and toasty. And so today, I still feel tired from fighting off the ‘flu and my energy levels are considerably lower. However, I have managed to keep the other symptoms at bay (fever, headache and cough) with a teaspoon of chili sauce in miso soup three times a day. By no means is this an instant cure-all but it does cut short the length of an ailment and lessons the symptoms so it is worth doing. I will probably continue this regime for the next 3 days at least. I have noticed that with natural remedies, it is not usually a once off dosage but rather a course.
Miso Soup with Chili.
Also, Chilis have nutritional value which can aid in mounting a proper immune response: vitamin A, C, E, B6, Potassium and Manganese and Riboflavin.
It is still raining here in Toledo…yay!! Have a Good Night everyone!!
Hello Every-one!! My Friday night posts have proven to be statistically unpopular probably because most of my readers are rather sociable people with a night-life at the end of the week. This is why I have chosen to write about a particularly nasty bug because it would never be a popular subject anyway. But nevertheless, it is worth talking about. This is a Friday Night Stuck At Home Post!!
Chagas Disease is also known as American trypanosomiasis and is a disease of the Tropics caused by the protozoan Trypanosoma cruzi which is spread by insects known as triatominae, or more commonly kissing bugs.
This was actually one that we found in our house…aarrghh!!! They send shivers down my spine!! This is the variety that tends to pop up in our area.
Kissing Bug.
At the risk of sounding petty, they do look rather nasty and evil, don’t they? We actually call them “The Bad Bugs” because they look so mean and intimidating.
Another Bad Bug.
During the day, triatomines hide in crevices in the walls and roofs. They are especially prevalent in thatched roof houses. These bugs come out at night and tend to bite people’s faces, ingest blood and also defaecate at the site of the bite. It is the faeces that are the problem and cause transmission of parasites at the site of the wound especially when the wound is scratched. The parasites then replicate within the blood stream.
(Yes indeed…this is turning into a Friday Night Horror).
There are other modes of transmission including blood transfusions, organ transplantation, breast milk and very rarely, contaminated food.
In terms of signs and symptoms, this disease is separated into acute stage and chronic stage. The acute stage is at the time of the insect bite and may include non-specific symptoms of fever, malaise, muscle aches, headaches, diarrhoea, vomiting and rash. Romana’s sign is a well recognised sign of Chagas Disease in which the patient presents with a swollen eyelid on the side of the face with the bite.
Whilst working in Punta Gorda NHI Clinic, I actually saw quite a few of these cases with the characteristic signs.
The majority of patients get better within about two months with no dangerous sequelae. There are a very small percentage that end up with symptoms of the chronic stage which may include problems with the heart (cardiomyopathy), dilatation of the digestive system and nervous system problems.
Phew…that was pretty heavy going…
There is medication (benznidazole or nifurtimox) to treat the disease if diagnosed in the acute stage. However, the medication still has limited efficacy in eliminating the parasites to give an effective cure. Diagnosis can be made by microscopic examination of fresh blood which will reveal the parasites.
What do you need to do to prevent Chagas Disease? Regular cleaning and sanitising of the sleeping areas are essential especially if the roof is thatched or the house unsealed. Mosquito nets are a cheap and effective preventative measure. Camping out in the bush can be especially dangerous and it is not recommended.
Having said that, most people do not need to worry about them (like all you guys out there). It is only a risk to those mad people (like us) who decide to live in the middle of nowhere next to the rainforest!!
Hi Everyone. Our Internet just came back on…it has been really erratic lately and some days we only have it come on for about 5 minutes at a time when some emails download but no connection to write back. Such is life in Belize. Well, we’ve been busy with medical calls of late. So, all farm and business stuff has been pushed to a minimum until things go back to normal. The rains don’t help either…and, I should also throw in the unhelpful conjunction of the stars for extra measure! Anyone waiting for coconut products is waiting for all our patients to get better, sunnier days and of course, the big stick (for knocking down the coconuts).
Of course, being doctors always comes first and we really don’t mind seeing patients. We just have so many other things that we like to do that it is sometimes hard to fit everything into our lives. For us, seeing patients is our gesture to people, the community and the universe, at large because we put such a huge effort into this work. Not only are our call-outs one hour, they sometimes extend to two hours and we don’t ask for extra money for this. The money that we receive from patients is what we like to view as a “gesture in kind.”
During these hectic, stressful and tiring days, I think to myself that we are so lucky that we can work together as doctors (and in everything else). Due to patient confidentiality, doctors should never talk about their patients to anyone else except to other medical colleagues. In our line of work, this is called “sharing the anxiety” or in more professional terms “de-briefing.” I am really glad that we can share the anxiety together!
It is nice when some acknowledgement comes our way. The last week or so, we have received gifts of fruit from patients’ relatives.
A gift of mangoes. This is great because we have no mangoes growing on our farm.
Mangoes.
A gift of kenip fruit. These are fruit with a sweet and acidic flesh…you gnaw on the fruit around the seeds and then the seeds can be kept, boiled up and then roasted to make a nut snack. Gnome really likes this fruit!
Hello Everyone. Happy Solstice to y’all!! I want to show you some pictures of the fresh kola nut…here in Belize, they call it the “bizzy nut” because it keeps you busy. The tree is of the Cola sp. and it is originally from West Africa. It really gets you moving (and buzzing) as it contains 2 to 3.5% Caffeine, 1 to 2.5% theobromine and theophylline. All of these are known stimulants and theophylline is of particular medical importance because it is used therapeutically for chronic obstructive airways disease, asthma and infant apnoea.
It is used in West African cultures in social gatherings, spiritual practice and to prevent hunger pangs. From our own observations, it is mostly the Garifuna (originally from West Africa) who chew on the bizzy nut here in Belize. They have been known to consume this nut during all night drumming sessions especially around National Garifana Day.
From our personal experience, one nut is equal to a triple espresso and it really gets you talking. It is good for social events and as a substitute for coffee or mate. It is very good for people with asthma and definitely a good drug for “where there is no doctor.” It is also a good natural diuretic. Gnome says: It is good if you like to entertain (but, are also cheap) because it gets everybody talking and at the same time, nobody eats any food because it is an appetite suppressant and so you save money! Our place is Boca-free!!
This kola nut was the original ingredient for Coca-cola although, now in present times it has apparently been omitted from this popular drink.
The dried nuts are available in Punta Gorda; I have mostly seen it stored in a jar at the local pharmacy priced at 25cents (one shilling) each. Cheaper than a coffee ($2 to 3) and twice the potency of coffee!! The other thing is to befriend someone with a kola nut tree because the trees are prolific producers and you can get bags and bags of it (to eat like a busy little squirrel). They are usually taken in the dried form and in this state, they are really hard in consistency…hard enough to break your teeth.
This is the fresh pod:
Kola Nut.
There are between 6 to 12 nuts (seeds) in each pod. We have eaten the aril around the fresh seeds and found it pleasant tasting…it is a bit like the mace in nutmeg but a bit more substantial in texture with a bland, sweet taste.
Open Kola Nut.
Fresh Kola Nut:
Fresh Kola Nut.
Get Bizzy tonight (or not…since there is nothing to do living in the middle of nowhere!).
Hello Everyone. It has been pouring down all day and we are surrounded by big puddles of water. It is dull, miserable and grey and so I naturally gravitated to the kitchen to make some comfort food. I made mochi balls with lotus paste. They definitely hit the spot…at least for the 15 minutes in which we were devouring them. Anyway, these are not the “Witches’ Eggs.”
Lotus Paste Mochi Balls.
These are the Witches’ Eggs:
Stinkhorn Eggs.
These are the stinkhorn mushrooms in their immature form. If you want to harvest these, you need to go to a spot where you have seen this type of mushroom, get down on your hands and knees and look and feel for these round protrusions above the soil. I found eight of them today and this is a picture of a the mushroom cut in half:
Stinkhorn Mushroom Egg Sliced.
These Witches’ Eggs are edible although I can’t find any recipe on the internet. A lot of information comes from other blogs where people have voiced their disgust over the gelatinous quality of this mushroom. Apparently, this fungus is cultivated by the Chinese and I was surprised to read that it is actually the mature form which they eat. They are dried and then re-hydrated for soups. Apparently, it is a highly esteemed ingredient in Chinese cooking and considered a delicacy. With the promise of delectability, I am definitely getting out there in my rubber boots to collect this for my soup.
Stinkhorn Mushroom.
I have known about the edibility of the witches’ eggs for a long time since we used to collect them in Scotland. At that time, we were really spoiled for choice with chanterelles, boletes and all manner of freshly foraged mushrooms that I didn’t really make much of an attempt to cook these ones up. Since I am now in Belize and mushroom foraging is less diverse, I have decided to give this mushroom another chance. I will be cooking it tonight so will post up my recipe tomorrow.
The protein content of these mushrooms in the egg form is comparable to that found in meat. Mmmm…something for the vegetarians to consider.
Also, this mushroom contains anti-inflammatory and anti-bacterial properties.
Oh, and this one is very interesting…according to a 2001 publication in the International Journal of Medicinal Mushrooms, the smell of the fresh fungus can trigger spontaneous orgasms in human females. Definitely another reason to get the rubber boots out and go mushroom foraging?!
