"My Favorite Things": A Tale of 2 Jazz Renditions

This gem came to me by way of the YouTube algorithm. I have listened to John Coltrane on occasion, and I must admit that "A Love Supreme" is a masterclass in concocting a magnus opus; however, on this occasion, one video recommendation kept on popping up for me: "How Coltrane Broke My Favorite Things" by Polyphonic. It was a mostly technical video that outlined the composition of Rodgers and Hammerstein's song My Favorite Things, which was written for The Sound of Music, initially a  Broadway musical that went on to become a famous movie. I must guiltily admit that I have never watched The Sound of Music (Rest in Peace to Christopher Plummer)...but I got to learn about this particular piece of music. Having never really listened to the song before, I must admit that it was erroneous of me to to be first introduced to the song in this way because I didn't initially hear the original whose runtime is under 3 minutes; imagine how much less I got to hear of Coltrane's rendition which almost clocks in at a staggering 14 minutes!

I did learn a few things though! Being of a melancholic persuasion, I do tend to prefer songs written in darker more solemn tones. I came to find out in my layman kind of way that those are Minor chords; and the joyous, more triumphant tones...those were the Major chords. My Favorite Things had an interesting mix of both major and minor chords that definitely appealed to Coltrane, and thus he translated his version into modal jazz. By the end of the video it was amazing that I knew more about the technicality of the song than I did about the actual song itself; therefore, I had no choice but to actually sit down and listen.

Coltrane's version just grabs you from the start: I initially thought that they were using some sort of reverb effect on the intro, till I watched other live videos on YouTube and found out that it was all done with acoustic instruments. McCoy Tyner on piano plays question & answer by playing out 3 notes, then responding with another set of 3 notes; Steve Davis (Bass) mirrors Tyner, but he only plays one note and sustains it for every 3 that are played on the piano; and Elvin Jones (Drums), well he basically strikes the cymbal once for every 3 - 3 note couplet that Tyner plays. The interplay between piano and bass sets up a very distinct sort of resonance, and then we delve into this very infectious groove.

For the longest time, I was not able to place which specific song this rendition reminded me of; finally, I figured out that it reminded me of Dave Brubeck's Take Five. That infectious groove that permeates this song is what's known as a Vamp (a repetitious progression that sometimes plays as an intro to a solo or can be randomly played as a bookend of sorts; Take Five probably contains one of the most famous jazz vamps on the piano, and on a recent listen I noticed that that vamp basically spans the whole song.

It is Coltrane's tenor sax that actually comes in to remind us that this is actually My Favorite Things, playing the melody from the original composition. He guides us slowly into the mix, first playing the darker chords, lets us get a taste of that infectious vamp, starts off playing the darker chords, then segues into the brighter chords where he lingers for a bit, then takes us back to the dark chords. After this Coltrane takes a seat and McCoy Tyner steps up to take over the reins. I have listened to various Coltrane renditions of this song, and I must say that this studio recording has the best version of the piano solo. In some portions, it sounds so simplistic; Tyner lingers on some note runs like he's letting the tune air out just a bit, and uses this to bookend the more flairy parts of his solo. I was surprised how much he was able to convey by sometimes playing only one note repeatedly (3:42), and there were times when he just went wild (5:08) and I can only imagine the mish-mash his fingers are going through at that moment in time. I love that live versions of a song usually afford an artist a chance for further exploration and the ability to add more flair to a solo; but in this instance, this was the perfect piano solo.

This song is unique for the part that it affords the Bass and Drums. Elvin Jones and Steve Davis are playing a drone that is really only there to support the Piano and Sax. They just sit there providing a "floor" for this performance. This doesn't diminish their skill in the least; in fact, some of the most beautiful moments in this song happen when the Bass & Drums interplay with the Piano: Tyner slowly fades out the piano, and you become more aware of the aforementioned Bass & Drums "floor", then Jones and Davis also fade out to match Tyner. 

Between the two of them, I think Tyner chose to play the more subdued solo so that Coltrane could have the more flourishy solo. Coltrane slowly unpacks his solo over the vamp, conservatively flowing over the minor chord section; he gets flashier when the major chords section comes in, and only really lets up as the song ends. His solo (more conservative than other of his renditions) can really only be appreciated by repeated listening. He has all the notes at his disposal, and he wants to let you see that he can use each and every one of them.             

Granted there are many versions of My Favorite Things by a myriad of artists, but the other version that caught my attention is Brad Mehldau's Jazz a Vienne 2010 (*Note that he also has two other versions: Marciac, which is a wholly sweetly melancholic piece, and a Trio version which sounds very much vamped-up like Coltrane's studio version). Mehldau plays it with darkened abandon. On repeated listening, it sounds to me like he borrowed some inspiration from James Brown It's a Man's Man's Man's World or Alicia Key's Fallin'. Unlike Coltrane, he sticks close to the melody of the traditional recording, but he does one helluva job exploring and re-interpreting it. After a very beautiful 2 minute 6 second prelude, he settles down and delves into a classical music exploration, which is at times done in a very dissonant manner that I've noticed some people have said is off-putting. It does appear to be the maestro showing us his chops (which some people may say that Jazz artists do at the expense of sacrificing the enjoyment of their music to a general audience), but I must say that there is a method to the madness. He uses all that dissonance to set up a dramatic conflict which crescendos at the 6:00 - 6:50 mark in a stunning bridge section. After 6:50, he just flies off the hinges, and it actually sounds like it's 2 people playing the piece on the piano. I'm not sure if I have him timed right, but he could possibly be playing in the range of 350 bpm. For him to basically be freestyling, developing the motifs on the fly, and playing that fast is just insane. What's more impressive is that he's playing 2 different melodies simultaneously: one is set to a rapid-fire pace, and the second is slower, measured, only a fraction as fast, and acting as a counterpoint (sounds like the tolling of a bell). I only wish there was a live video so I could see what playing this really looked like. After all the excitement, he brings things full circle with the re-introduction of the sweet melody that started it all; he then slows things down and guides us home.

Really don't know how many times I've listened to both these pieces, but each time it brings me immeasurable joy. The Coltrane rendition, while being quite a long piece, is the more approachable of the two, the easy listen (in the vein of Take Five). Mehldau's rendition seems to meander a bit, at first being easily approachable, then seeming to lose its way; in my opinion, he actually enhances the song by having the "bitter" middle section break apart the "sweet"; the sweet never is quite as good without the sour. It might not be the easiest of listens, but it is well worth the patience.

Take a chance on listening to these two contrasting renditions. You won't be disappointed.

God Bless.

  

Spider-Man: No Way Home "Spoiler-Free" Review

This is my first foray into anything MCU this whole year. I missed out on "Shang Chi" while it was in theaters, and I still haven't yet managed to watched the prolific "What if..." anthology yet. Anyway, I am glad to say that "No Way Home" reflects a return to form for this Spider-Man series. I had honestly had this series pegged as yet another "Iron Man" trilogy where it was just a case of diminishing returns with each returning installment. The underwhelming "Far From Home", which basically played like a bootleg "If Looks Could Kill", certainly filled me with a whole lot of doubt, but I'm glad that my doubts were eventually cast aside.

Far From Home starts off right where No Way Home ended: Mysterio, in a last ditch attempt at revenge, outs Spider-Man's secret identity, and now the whole world is suddenly aware that he's Peter Parker. Unlike the usual peril for his loved ones that tends to be occasioned by such a reveal in the comics, here it just proves to be an unbearable nuisance to those associated with Peter. 

People familiar with the comics will be aware that the MCU has attempted to adapt the much maligned "One More Day" storyline for the big screen. In that outing, Peter in his ever self-sacrificing way makes a deal with the Devil (Mephisto) in order to save Aunt May's life. The MCU doesn't typically translate these storylines to screen verbatim, and in this case, Dr. Strange is used as a welcome substitute for Mephisto. Dr. Strange, appearing to be of a more mellow demeanour towards Peter since Infinity War (& Endgame), opts to help him out by basically making the world forget about the secret identity. The MCU's Spidey is still pretty much a child, so of course he tries to throw all kinds of caveats at Dr. Strange about people who should be unaffected by the "forgetting spell", and this ultimately messes the spell and throws his reality into disarray.

This is a return to form for Spider-Man; the "home" series has been lacking that Je ne sais quois of what we've come to expect from Spider-Man. This was basically spelled out in Captain America: Civil War where during our introduction to Peter, in his first talk with Tony Stark, he basically stumbled over the "With great power comes great responsibility" pitch. They then proceeded to basically write out Uncle Ben and handed over this surrogate parent role to Tony Stark. Spider-Man is a great hero because he's basically had to handle most of his adversity by himself, and the MCU basically knee-capped him by making him a Tony Stark fanboy. In Homecoming, he spends his time trying to earn Tony Stark's favour; in Far From Home, he finds himself living in Tony's shadow, and still ends up making the biggest rookie mistake. And why on earth are they referring to his Spidey sense as "the Peter tingle"? (Most annoying change ever!)

The great thing this time around is that there isn't a single mention of Tony Stark. Sure enough Stark-Tech is still involved in the MCU, but even the memorial murals that seemed to permeate Far From Home are gone now. After Peter makes his debacle, he goes about fixing it in the most adult pragmatic fashion possible with the best outcome for everyone involved. From the trailers, you'd know that the mechanics of this story involve "The Sinister Five" - Doc Ock, Sandman, Electro, Lizard, and Green Goblin - drawn in from their different corners of the Spiderverse, and ensuring good outcomes for this disparate group of villains poses a high stakes game that will take everything in Spidey's arsenal and more. A superhero is only as strong as his rogues gallery, and the foil against which he is compared. Alfred Molina's "Doc Ock" and Willem Defoe's "Green Goblin" are the standouts in this movie. Both of them are tragic figures born of intellectual hubris; where they differ is that "Doc Ock" is still fixated on his goals, whilst "Goblin" is psychotic and vengeful. These two provide the most poignant moments and it really is great to see them rehash their performances from the Raimi side of the Spiderverse. 

The villain who really gets the biggest makeover is Jamie Foxx's "Electro". The all-rage-all-the-time demeanour of a fanboy turned villain from The Amazing Spiderman II was a rather poor take on the character; this time around he's played as a straightforward snide character with an unfortunate penchant for being literally power-hungry. He doesn't get too much time in the movie, but every bit of it is deeply redeeming.

I have to say that the most beautiful elements in this movie was the addition of Dr. Strange. His mysticism is such an eclectic bag that allows him to fit in well within any portion of the MCU; the addition of the trippy Inception-esque visuals also manages to seemlessly fit in to the story, and always enthrall.  With the events that this story sets into motion, the MCU have done more than enough to whet our collective appetites for the Dr. Strange sequel that's due to come out later this year.

The story is very well written and fast-paced, and the action is top-notch. The only gripe I had with the movie is that Marvel can sometimes be indisciplined when it comes to lingering over their jokes. One time during the finale, it got so bad that it took me out of my suspension of disbelief. Shaving out a few minutes of this indiscipline could very well have given us a tighter story; other than that, there was a great deal of fan service draped out for all the fans on this outing. Truthfully, you can't please everyone, but I think you can achieve a fine balance that caters to the masses. 

The trailers managed to keep most of the story under wraps, so I will end the review here, and save the rest for a "Spoiler" review; but suffice it to say, this is the strongest Spidey offering that the MCU has ever put together. This is the most mature presentation of Spider-Man thus far, and a delight to watch. Definitely gets an "A" grade from me.

God Bless.

Not All Doctors Are Created Equal!

From "The Fourth Plane"

I remember that it was a day much like any other at my first job as a Medical Officer. Internal Medicine ward round, longer and more nerve-racking than it ought to have been. My Consultant was a Nephrologist of some renown, but she had a peculiar bedside manner for a practising physician: she could be dismissive, condescending, insensitive or downright incendiary as we went about the business of assessing the patients. As we got towards the last room in the female ward that day, we had a new unclerked patient (let's call her "*Eunice") before us who appeared otherwise normal. Lately, she had been experiencing a recurrent localized right lower abdominal pain; her past medical history was hitherto unremarkable. My Consultant had me assess Eunice briefly,  and the only symptom she had was marked tenderness in the lower right abdominal area of her abdomen. I remember suggesting that it seemed likely that this patient might have been suffering from appendicitis, and that she might actually be more of a surgical patient. The Consultant wasn't having any of it and proceeded to berate me in front of the team, which included medical and clinical officer interns, nurses, physiotherapists, nutritionists and a counselor (and let's not forget the patients that were within earshot):

1. Why would I think it was an appendicitis yet the patient did not have the typical "septic" look of an appendicitis patient?
2. Wasn't her abdominal pain localized, and without the typical progression seen in appendicitis? Where are the other signs suggestive of appendicitis? 

I halfheartedly remember suggesting that perhaps it was an atypical case, but she was having none of it; I was summarily told to stop jumping to conclusions (known more technically as "confabulating") and a plan was made to work up the patient in terms of lab work and some imaging studies.

Getting insulted was usually par for the course, so I just took it in stride. Apart from that slight, nothing else really stirs in my memory from that day. Anyway, the ward round - which spanned 2 wards, and sometimes involved consults in other areas of the hospital - took so long such that the rest of the day typically involved drawing samples and tending to other ward procedures. I was also charged with attending to the Outpatient dialysis patients. A lot of the time, you would end up getting the results the next day, so it wasn't something that you could respond to too quickly. Provided the patient wasn't knocking on death's door, a little waiting wasn't really going to hurt.

The next morning was joyously a Thursday. Thursday was the one day in the week that I got to lead the ward round because it was the day when my Consultant was otherwise occupied running the Medical Outpatient Clinic (MOPC). This meant that we usually finished the ward round a lot faster. As I was conducting a preliminary assessment of patients prior to the ward round, I remember asking one of the clinical officer interns for the list of our patients. When I received the list, I noted that Eunice was unceremoniously missing. When I inquired why, I was told that she had been handed over to the Surgical Team. My interest was piqued and I decided to glance in her file to find out what had happened. The sonographer who performed her abdominal ultrasound had detected a mass in the tender part of her abdomen - an appendiceal abscess. What appeared to be more likely is that Eunice had probably suffered from chronic appendicitis; this inflammation was eventually "walled off" by the body, protecting her from the more adverse effects associated with a leaking/burst appendix.

The irony of it all is that a crowd was present for my ridicule, but my moment of vindication was mostly a private affair. Dear God life can be so unfair!

I must admit that I have been reading and watching a lot of news concerning Covid-19 lately. Part of the reason for this is that so many medical updates keep on arising concerning testing, and many of my colleagues on the front-line worldwide are providing a lot of useful advice that might prove helpful in our local battle with the disease. Another reason is to see how countries are dealing with the economic push-back from the virus, and to get a sense of what stimulus measures might be needed to protect the citizenry from the economic ravages of the virus. However, the last bit consists of the debacle-prone US response (with all its bells and whistles) and, surprisingly, tales of conspiracy theories and what not. Just recently, I caught a segment on Fox News whereby Dr. Oz was talking about possibly getting children in the US back to school after a Lancet (Medical Journal) study had shown that such a move came with a 2-3% chance of increasing the total US mortality statistics. This is of course par for the course when it comes to Fox News recently, and though they keep on emphasizing how precious human life is, it a repetition of their stance that some amount of human life sacrificed for the sake of the economy might not be such a bad thing. However, policing a news media outlet is not my duty; as a trained medical practitioner, my job is to at least make sure that people are getting sound medical advice wherever they choose to consume it from, and especially that is being delivered by a sound medical professional.

Now, rightly so, Dr. Oz drew a lot of condemnation for his comments and ended up having to apologize. This is not the first time that he has been forced to walk back his comments as he was actually brought before a congressional hearing to account for claims he had made on his television show about certain weight-loss regimens. For those who may not know it, Dr. Mehmet Oz is a renowned Cardiovascular Surgeon who is a media sensation who got a big push by being endorsed by Oprah Winfrey. His skill is unquestioned in the field of cardiovascular surgery where he is known to be an innovator; however, it is his media sensationalism that typically gets him into a lot of trouble.

I remember chatting with a group of my high school alums on Whatsapp and I remember being peeved at a suggestion by one of my friends that they needed to be hearing more from doctors in the national discourse during this period of Covid-19. That remark set of a powder keg in the group that drew the ire of the health practitioners. This came against the background of disdain and distrust that Kenyans have continued to hold towards doctors and nurses since a massive 100+ day strike in 2017 which was meant to address issues of poor renumeration and working conditions, and inadequate functional capacity. The politicians of course turned things around and made it seem like it was purely a salary push by a money-hungry lot, and consequently medical professionals and institutions were lambasted by the citizenry. Long story short, hearing my friend calling on the medical professionals to start waxing lyrical was like opening up an old wound. In retrospect though, having had some time to calm down, I can admit that my friend was right. People do need to be hearing from sensible medical professionals at a time like this. The amount of sensationalism, hoaxes, "miracle-cures" and conspiracy theories is proof of that.

I think that people understand even less about the practice of medicine these days. In the old days, people were awed about the profession, but nowadays the prevailing sentiment might be that the internet has bridged the divide between clinicians and patients. It is therefore useful to understand the typical career path of your typical medical doctor. In Kenya, there'll be 5-6 years of medical school (post-secondary), followed by a 1 year internship rotating in 4 major departments; from there you can expect 3 - 5 years of specialty training, and after that you add on as many Fellowships as you want, and you can aim towards being a professor, etc.
Now, since I am going to discuss Dr. Oz, I'll give you a glimpse into the American path of ascension.

• 4 years of a pre-medical degree
• 4 years of a medical degree
• *Residency Program
• Fellowships

*The 1st year of the residency is pretty much just an "internship" (semantics). Unlike the Kenyan experience, American doctors do their internships specifically in their field of interest. Surgeons have a surgical internship, physicians do an Internal Medicine internship, etc.   
    

The aim of medical training is to start you off with as wide a base of medical knowledge as possible, and then whittle that down to the things required only for your area of specialty. Back in the day there were people who dabbled across the field of medical specialties, but nowadays - short of someone being a genius - such broad focus is discouraged. True Story - I remember being blasted for showing lack of focus during a surgical specialty interview at a local medical university. Why? you might ask. Because I had listed that I had performed independent research on Phytoremediation on my curriculum vitae (CV); the same CV further states that

"I aim to become an experienced doctor specializing in surgery, with a view towards
practicing and teaching medicine while infusing my practice with environmental
consciousness to enhance the focus on preventive medicine."

The Plastic Surgeon on the panel had a look of disbelief on his face; it was like this was blasphemy!

Therefore, applying this logic to Dr. Oz, who got his joint MD and MBA degree in 1986, the man has been a PURE SURGEON since 1986! This is not the kind of individual you want to be getting your principal Covid-19 findings from (media sensation or not).

The above 2 images have been part of a meme sent out by many of my medical colleagues, but I think that only the medical field is in on the joke. This is the grim reality: most of the specialist medical professionals do not have the skills to deal with this Covid-19 pandemic; but if we cannot keep the numbers of severely sick down to a level where the healthcare system can adequately handle the numbers, then every medical practitioner will eventually need to be drafted to help with the situation. They'll just have to be retrofitted and adapted to the situation.

If this post wasn't already too long I would've delved into the reasons why medicine is not the homogeneous field most people tend to think it is. There is a lot of direct antagonism going on that is the subject of much comedic gold.

• Surgeons vs. Anaesthetists, where surgeons believe it is the joy of an anaesthetist's day to cancel a scheduled surgery for the flimsiest of excuses. Anaesthetists in turn believe that surgeons will steam-roll through any procedure without considering the risks. (It's the relationship portrayed in the title cartoon!)
• Orthopedic surgeons being of questionable IQs (despite the research)
• Those who are not good enough to be surgeons become... (I once remember a surgeon toss this gem in jest at his accompanying scrub nurse)
• Doctors vs. nurses
• A surgeon only sees a surgical solution to a problem. A physician only sees a medical solution to a problem (typified by my experience with my Consultant)

All this aside, the best results in our profession (and its allied fields) are usually achieved when we have a healthy dose of respect for everyone and their training. The best approaches are always multi-disciplinary. Therefore, next time your relative with Diabetes/Heart Disease/Lung Disease etc. shows up for an elective surgical procedure and another doctor gets called in for a specialized consult, please understand that the hospital is not simply trying to pad your hospital bill; what they are trying to ensure is that the elective surgical procedure doesn't end up degenerating into a complicated affair with death as an outcome.

This pandemic is stressful for everyone, more so the medical fraternity which finds itself faced with a new enemy for whom our typical treatment regimens don't seem to be working. Despite that, we are soldiering on, and we are looking for our fellow (not-so-flamboyant) colleagues to provide answers. We are listening to the Researchers (Virologists, Pathologists, Epidemiologists, Biotechnologists), Infectious Disease Specialists, Intensivists, Critical Care nurses, Respiratory Therapists, Psychiatrists/Counselors etc. to help us chart the way forward. Their work will eventually filter down to the other medical professionals and inform our practice, and finally down to the general population.   

Now, more than ever, it is important for people to interrogate their sources of information. It has taken the medical field forever to get down to the level of Evidence Based Medicine wherein we have to let the efficacy of the science guide our practice. We are not witch-doctors after all! This level of supervision has not made its way to streaming and social media, and thus all manner of dubious claims are being made about this disease and its treatment. We have no way of policing all these dubious claims, but I would ask people to exercise restraint in dispersing all this pseudo-science. Sars-Cov-2 is out in the open and it will be studied intensively for many years to come, then we will finally have the truth; until then, for all these medical pundits making all these claims, remember to assess their backgrounds with the following lens

1. Researchers trump Classical Doctors
2. Internal Medicine specialists trump Surgical Specialists
3. Alternative Medicine specialists are pretty much at the same level as the typical civilian
4. Not every PhD has the acumen to discuss medical issues
5. Always look for conflicts of interest. The person is certain to be selling their dubious miracle cure as they tear into the conventional medicine, i.e. Miracle Mineral Solution (MMS) which is just INDUSTRIAL BLEACH; otherwise, look for them to be espousing a particular agenda
6. Check for reports about them being called out by their professional peers or censured by medical regulatory boards. This kind of behaviour is always a continuum       

This current sensationalism of medicine reminds me of that time when "The DaVinci Code" movie graced the movie screens. I remember that it was touted to have made a lot of people lose their Christian faith, and I wondered if watching it would have been detrimental to my own; then I watched it and I felt bamboozled. I remember at one point the author (Dan Brown) randomly included "The Peace of Westphalia" and used it to make a nuanced argument. I wouldn't have known anything about that incident if it hadn't been for the boring "Church History" lessons (my apologies Mr. Borruso) that I'd had to take while I was in High School, and thus I could see that the author was merely sensationalizing historical incidents that most people are not aware of.

The same exact thing is playing out with medicine right now. To tell you the truth, medicine - just like History - is very boring! Let me clarify, studying/reading medicine is extremely boring! You better thank a scientist who is able to take the time to truthfully summarize a lengthy research paper into snippets that you can digest because reading them is hard work! Being boring notwithstanding, it does not give us practitioners of science the right to mislead people. Always remember that

"The most dangerous untruths are truth slightly distorted." 

Therefore, as a medical practitioner, I will do right by my patients or anyone who needs some clarification. Honesty, Discipline, Empathy and fortitude will get us through the rigours of this pandemic. However, despite the readily available stream of information from social media and video streaming services, we all still have a responsibility to practise patience and critical thinking. There is no need for panic.

God Bless

 

 

Empathy

As far removed as I am from my internship days, every once in a while a specific memory pops into my mind from way back then. This one specific memory has been popping up from time to time; perhaps it's relevant for the times we're in. So here goes.

During the latter part of the Internal Medicine rotation, I remember early one evening, as I was almost leaving, I ended up being called to attend to a patient. This patient was neither in the ward nor in the casualty area; rather, he was at the TB clinic area, which was an Outpatient clinic where TB patients usually showed up for follow-up as they went about taking their medication. This was something that the clinic was able to handle so well without involving the other doctors, so it was something of a novelty for me to be called in to the clinic. I got there to find a young man - probably in his early 30s - flanked by another gentleman who looked to be in his 60s.  The elderly gentleman then proceeded to tell me a story. The young man was his son (I'll refer to him henceforth as *ALEX), and was a prospective patient; having been diagnosed with Pulmonary Tuberculosis (PTB) a while back, Alex had been started on treatment for the condition. Unfortunately, he was also an incorrigible drunkard, and his usual modus operandi had consisted of initially taking the TB medication (which doctors refer to as RHZE) then somewhere along the way - probably once his symptoms would subside - he would go back to his drunken ways and stop taking the medication.

Let's get a little technical here: the treatment for TB consists of 4 medications: Rifampicin (R), Isoniazid (H), Pyrazinamide (Z) and Ethambutol (E). You start off taking all 4 for 2 months (RHZE), then switch to 2 drugs - Rifampicin and Isoniazid (RH) for the remaining 4 months. There are variations to this dosing, but this is the simplest one for run-of-the-mill PTB. People should be aware that these drugs do have a whole bunch of side effects, most common of which is liver toxicity and injury.

So, by the time I encountered the young man, he had basically defaulted on taking his medication on 4 separate occasions. During that time, he had gone on to infect 3 other people in his village area; thus, he had been served with an eviction notice by his chief (and the villagers) that if he was found within the village, he would basically be beaten and burned to death! Father and son had thus ended up moving to the township area to stay with a relative as a stop-gap measure, and they had come to the TB Clinic in order to get him started on treatment. Because Alex was a serial defaulter, an option that has usually existed is for such patients to be institutionalised in a prison facility where it can be ensured that they take the full course of their medication. I remember making a call to the nearest prison facility, but they insisted that they were in no position to accept such a risky individual; the prison was already overcrowded, and imprisoning someone suffering from TB was a recipe for disaster.

With that option off the table, I called the Internal Medicine Consultant. He was very categorical that the patient was high risk, possibly suffering from MDR (Multi-Drug Resistant) TB, and thus there was no way he could be placed in our regular ward. I broached the idea that perhaps the patient could be placed into our TB isolation ward (our old Amenity Ward) while we tested him to confirm that he was in fact suffering from MDR-TB, but my consultant categorically refused. "Send him to Homa Bay" was the only solution I was given.
Now Homa Bay does in fact have a facility that can serve MDR-TB patients, but you needed to first have a confirmatory test (Gene Xpert) which confirms infection with a drug resistant strain of TB. Without that confirmatory testing, I worried that I would be sending the patient on a long journey only for him to be turned away once he arrived at the Homa Bay facility. In addition, if he was in fact infectious, he risked infecting an even larger number of people if he used public means to travel to that same facility.

My hands were tied in the matter, and I remember relaying this to Alex's father. This had been a surreal experience, sometimes so comical that a chuckle almost escaped my lips (damn that morbid medic sense of humour!). I was not expecting to see his elderly father almost break down into tears at the hopelessness of the situation! Contrasting that with Alex's laissez-faire attitude, this felt like a case where a careless man deserved to get his comeuppance. Sadly though, there was a family that was being inconvenienced by this man's carelessness, and that had to factor in there somewhere. Eventually, in contravention of my consultant's advice and against my better judgment, I ended up having Alex housed at the amenity ward so that he could have Gene Xpert testing early the next morning. I think my stomach was in knots that night as I thought about the prospect of having admitted a high-risk patient; worse still, if my consultant had found out, my goose would have been cooked. 

My elation was palpable on the next day when I eventually found out that he was suffering from "garden variety" TB. This meant that he could be treated at our facility. I hoped that the idiot would finally stick to his treatment for the prerequisite 6 months this time around, but, alas, I don't know how the story ended.

Seems like ever since this COVID-19 popped up, it really is the only infectious disease that's being talked about. In a most ironic twist, it has thankfully reminded people that hand hygiene and cough etiquette are matters of utmost important. You'd have thought that a high prevalence of TB and Cholera (among other things) would already have clarified that fact! After this is all said and done, we'll probably have the most hygiene-conscious generation of individuals ever.

The sad thing about being smack in the middle of this pandemic is that we can't even be 100% sure of the transmissibility of this virus. The asymptomatic carrier may have an extremely large role to play in spreading Covid-19. An oft-quoted line of wisdom with regards to Influenza used to suggest that you are most infectious before you start to show flu symptoms (might be more true for Influenza B than A). This same line of reasoning seem to hold true for Covid-19, and a pre-symptomatic or asymptomatic carrier might just go about shedding a lot of viral particles without being any the wiser.

I keep thinking back to how my response to this virus changed as the situation has evolved. Even while at the clinic, initially I wasn't afraid to shake hands. At that point, before seeing a patient, I would casually glance at their notes and only don a surgical mask if the patient exhibited respiratory symptoms. From there, it evolved to no handshaking, having the surgical mask on at all times, and eventually progressed to preferentially donning the N95 mask. I went from looking at my scrubs as benign items that I was confident to walk into the house while wearing (at the end of a shift), to germ-infested items that are tracking this nasty virus to my humble abode each day.
In case you might not have guessed it, a lot of your doctors and nurses are the biggest hypochondriacs out there. It started out during medical training when we were exposed to a whole bunch of medical conditions in the literature. Sometimes we could feel the lecturer diagnosing us with the rarest conditions on the spot; but because we stoically kept quiet, I think we eventually just overcame our worries and fears to continue with our chosen careers. It does of course help that once we begin actually practising medicine, we discover that "Common things occur more commonly"; and in case something uncommon jumps out at us, between our hands-on practice and help from peers and superiors, we can usually fashion a suitable response to the task at hand. Truthfully speaking, Covid-19 has a lot of us worried. There are no standard treatment regimens as of today for the disease, and there is no vaccine in sight until next year (at the most optimistic estimate). The disease remains a really theoretical concept for the ordinary mwananchi, but we in the medical field can physically visualize the downward spiral for an affected patient. We've encountered these effects with other diseases, but never on scale that's potentially this massive!

I also keep thinking back to a few of the patients that I'd been encountering in the previous months. I was - initially - particularly annoyed at the patients who'd travelled from hotspots; instead of quarantining themselves off for the agreed 2 week period, they were breaking quarantine to come into the clinic to seek reassurance. Practically all of them were asymptomatic, but they still worried that they had possibly put their families/loved ones in danger and worried about the fallout. They wanted to have themselves tested, but the truth of the matter was that only government labs were conducting the testing, and due to scarcity they were only really testing patients with marked respiratory symptoms coupled with a positive travel history or contact with a Covid-positive individual.

I can understand their fears. For the longest time I have had 2 fears concerning this condition:

1. Suffering the most severe symptoms
2. Unwittingly spreading it to others

I daresay that if all I was going to encounter was the typical flu symptoms - with the assurance that I'd be immune thereafter - I'd rather get it over with (same way parents used to opt for their kids to get exposed to Chicken pox). All I could do was reassure them that they had an 80% chance of being on the good end of this condition. Until such time as they would develop severe symptoms, I advised them to simply continue with their quarantine schedule whilst monitoring themselves.

Lately, however, I've developed a 3rd fear that stems from our government's response. As a matter of policy,

"Until the Ministry of Health establishes the existence of sustained community transmission, all confirmed positive Covid-19 cases identified should be monitored closely at a HEALTH FACILITY ISOLATION ROOM...Once sustained community transmission has been established, home management of mild cases should be encouraged."

 *Interim Guidelines on Management of Covid-19 in Kenya (PDF Page 13) - Available for Download here

I'm of the opinion that because we have under-tested thus far, we have already reached the level of sustained community spread. This is the reason that I'm all for random mass testing of the general population because it will push the number of confirmed cases up exponentially, which will in turn escalate the government's response; ideally, this should mean home care for Covid-19 positive individuals with mild symptoms.

The government's understanding of the situation and its "playbook" keeps changing as time goes on. After a recent webinar by medical professionals, I feel like the government might choose to accommodate a Chinese solution, meaning isolation of POSITIVE people, whether they might be asymptomatic or mildly symptomatic. If that's the course they follow, picture a whole bunch of people who might at most only require Paracetamol, cough syrup and bed rest being isolated away from the general population in designated facilities like hospitals, stadiums and high schools.

I also appreciate that the government also needs to do contact-tracing of those individuals that have possibly been exposed to a confirmed Covid-19 patient. Defining the extent of the disease's spread is important, but I believe that we also need to safeguard the dignity of our citizen's who've been inadvertently exposed to this disease. These contact-tracing officials riding gung-ho into a neighbourhood in the name of carrying out their duties risk panicking residents, or even worse turning the infected/affected into pariahs within the community (like Alex in my initial story). Ironically, to quote Donald Trump,

We cannot have the cure be worse than the problem

    
Life will go on for most of us beyond this virus. We cannot afford to "burn" people in the community in the name of protecting everyone else. Despite how crazy things might be around us, we must retain our humanity through the whole experience.

I really sympathize with the government as well. It can't be easy charting a course in the chaos with all the differing opinions about their approach (though I suspect they're having a much easier time than the United States). I can respect that they've chosen to have people wear masks like the CDC recommended (but not the WHO), but hate that they've left us at the mercy of hoarders and quacks supplying the goods. Have they even stockpiled enough masks for healthcare (and affiliated) workers in this same period? Then there's the problem of indiscipline among Kenyans. In much the same way that overseas travelers failed to self-quarantine, it can be postulated that Covid-19 positive patients are unlikely to self-isolate of their own volition (as recent reports of mischief would suggest).

We have a powder-keg of a mess on our hands, but there is always hope if we empathize with those that we mean to protect. Worldwide, Covid-19 is showing us that traditional inflexible systems cannot work. Just like the fictional human society in Star-Trek, we might be forced to abandon concepts like "profit" and "individualism", and just work together to confront a common unseen enemy, if at least only for the moment at hand. At a countrywide level, our politicians need to make sensible policies for the citizens they govern. Despite all the buzz about Kenya being a middle-income country, they know that we are still a fledgling developing country with a vast vulnerable population. Their policy needs to acknowledge that and put in place measures to safeguard the most vulnerable; ignoring this will only lead to revolt.

At the local level, there needs to be public health education on a massive scale. People need to feel entrusted with the knowledge and acumen to fight this disease. They also need to be reminded that with all the RIGHTS that they exercise there are also congruent RESPONSIBILITIES. The only way we come out of this any better is by abandoning the inefficiency and bad habit that have failed us in the past; we need to empathize and we have to be better. Our very survival depends on it.

God Bless  

2020

I was hoping to have started 2020 better than this. For starters, I have totally procrastinated and abandoned this blog for quite some time. I've missed writing up a couple of movie reviews, and then the knockout punch came with the demise of one of my favourite artists - Lyle Mays. Being the glue that held the Pat Metheny Group together, I'd hoped that they would eventually bless us with another album that could stand the chance of eclipsing their 2005 Magnus opus "The Way Up". Sadly, we won't get that opportunity. However, Pat Metheny released a new album "From This Place"in February, which, it turns out, is the first album I've ever pre-ordered. I'll be sure to talk about that in another post.

However, another matter has us occupied altogether. Seems like Mother Nature turned on us in the  starkest of ways, unleashing on us the ongoing COVID-19 pandemic. Now, as a clinician, my mind is always prepared for this kind of an incident (at least in theory); when we had a teen die of Acute Respiratory Distress Syndrome (ARDS) secondary to the flu at a local hospital last year, we braced ourselves for what we thought might be the next big thing. It really took till the end of 2019 for us to develop the challenge that we've always felt lurked out there.

It would behoove me to blame Mother Nature for this specific occurrence; also, unlike conspiracy theorists, I DO NOT believe that this new virus (SARS-CoV-2) is a bioweapon. It's very insidious, and once you pair that with it's ability to "return-back-to-sender" you understand that it makes for a very dreadfully poor bioweapon. The problem here is that wildlife trade that going on in parts of China. Let me clarify that this is not me launching an attack on people's food choices, vast as they may be. While we're on the subject, I remember that (while I was in med school) one of my Mandarin Language teachers used to recite a long held gem of wisdom about food choices in Guangdong (Southern China)

"If it moves on the ground, apart from bicycles and cars, and if it flies with the exception of airplanes, then it is considered edible".

I have paraphrased it slightly, but that was the general gist. Though it was uttered in jest, living in China basically exposed us to a fair share of "exotic" delicacies. Digging into the history of the country reveals that some of these cuisine options came about in times of hardship, and we can't begrudge them that part of their past.

What is problematic, however, is how those animals are handled prior to slaughter. We've known for a long time about zoonoses/zoonotic diseases that can spread between species because we sometimes end up as unwitting sufferers of such conditions. This continues to be a relevant matter as we encroach further into other environments like forests, caves, etc. that we've been relatively isolated from. The wildlife trade in China actually complicated things a bit because by all admissions all manner of animals were held in pretty close proximity to each other; this created the perfect petri dish for a zoonosis to spread between the species, and maybe along the way it run into a multiplier species that set off this whole issue. Due to the fact that we are in the middle of a pandemic all this is a matter of speculation. Consensus seems to suggest that the virus probably originated within Bats, but the missing link in the chain prior to it making its way to humans is still a matter of research (people have suggested a Pangolin).

Regardless of the way in which this thing came into existence, the rate at which it has been able to spread so prolifically has accentuated just how much of a "Global Village" the world has really become. We saw it take root in China, and watched as it spread first to adjacent Asian countries, then made its way across the world to everyone's doorsteps. It's not unrealistic to say that it surprised everyone, but what has come to the fore is that some people have been better at dealing with this situation. The fact that Italy, Spain and France have taken quite the walloping despite their remarkably high level of healthcare is a truly sobering fact. The United States' response has, however, proved to be quite the conudrum; coupled with its late response, its president's "unique" personality, bipartisan distrust and its administrative composition, we are being treated to widespread confusion on a massive scale. In hindsight, Trump and the Republicans might be forced to admit that their "hack-and-slash" treatment of measures already put in place by previous administrations might very well be the country's undoing. Also, maybe they also need to accept that this is not a problem that can be dealt with from a strictly "capitalistic" point-of-view; this virus will not bend to accommodate our inclinations, and therefore our systems must ideally be molded for the best outcomes. 

The US, however, is not an isolated incident; here in Kenya we are suffering something similar, but on a smaller scale. Granted, this COVID-19 situation is a one-of-a-kind occurrence, and better equipped countries have also found themselves overwhelmed, what is going on in Kenya is a mess of our own making. The government won't outright admit it, but there was a particularly slow response to closing of our borders when you consider that a China Southern plane was allowed to bring 239 passengers from mainland China in late February before China had gotten control of the pandemic on its end. When pressed for answers, government officials only seemed to focus on the fallout of failing to let the economy progress in business as usual fashion; it's also likely that they feared retaliation from China if we didn't allow their flights into Kenya (I fear that our overwhelming debt owed to the Chinese doesn't give us much room to negotiate). It must be poetic justice to note now that China has its COVID-19 situation under control, it has forthright banned foreigners in possession of valid visas from returning to the mainland; they are basically doing the right thing to safeguard their borders and prevent importation of the virus back into their country.

We are currently waiting for the COVID-19 pulse to hit the country. Thus far the government has locked down the borders, stopped all international flights as of midnight March 25th (with the exception of "evacuation flights"), put in place "social distancing" measures and has initiated a dusk-to-dawn curfew (7pm - 5am); recently, concerned that 81% of confirmed cases were within the vicinity of Nairobi, they've initiated a lockdown of the Nairobi Metropolitan area to prevent the virus from spreading to the rural areas where it is felt that it might be particularly passed on to grandparents and similarly aged individuals.

The government is perhaps scared to admit its folly in this matter. A lot of medical professionals (myself included) will openly admit that the virus has already achieved nationwide sustained community spread. The numbers of confirmed cases remain low because of one factor alone: testing. This is a scientific endeavour, and the only real way for us to quantify how well we are doing in this situation is by our ability to measure the situation. The truest measure is to pinpoint the infected and to keep the infection from spreading. If we wait too long, there are other quantities of measure that will start to surface - Deaths! Ideally, we cannot afford to wait that long. The government thus far, because of the shortage of testing kits, is stuck testing those people it had forcibly quarantined as well as the symptomatic cases that are coming in to hospitals; this comes to an average of ~300 tests in a day.

I applaud the government for what they have done thus far, and for where they are headed. However, they need to set their sights higher. They already lost the first battle to keep the virus out of our borders, and we have to move on. People were not busy sitting in Nairobi as we awaited the government's "Will-it/Won't it" decision to place the country under lockdown; people already panicked and traveled beforehand to the rural areas. As insidious as this virus is (in comparison to something like Ebola), we have no idea what a COVID-19 sufferer looks like. A majority of people will suffer anything from no symptoms to mild symptoms. That is a vast range including anything from a seemingly normal person to simple upper respiratory tract symptoms (coughing, sneezing, runny nose, itchy eyes/ears/nose, loss of taste and smell, sore throat and voice hoarseness) to flu symptoms (fever, headaches, malaise, chills and rigours, muscle and joint aches, nausea, diarrhoea and vomiting).

I can't help but smile everytime the WHO/CDC adds another symptom to the list. Those of us who treat Cold and Flus on a regular basis recognize that there's nothing unique that distinguishes COVID-19 from regular flus and colds. Between the dust and pollen in the air, we also have seasonal allergies (Allergic Rhinitis) and asthma to deal with. The few people who will develop the characteristic severe symptoms will find themselves in an extremely unlucky position characterized by medical personnel's worst bunch of condition:

1. Acute Respiratory Distress Syndrome (ARDS)
2. Kidney Failure
3. Sepsis
4. Multiple Organ Dysfunction Syndrome (MODS)
5.  Death

This is a unique time in medicine because a lot of us are basically flying blind. Thanks to a bottleneck in testing, we don't know how many infected we are actually dealing with. We have no vaccines and no particularly proven treatments for this specific disease, so we are relying on measures that have saved us in the past and hoping that the experience of countries that have been hard-hit by the pandemic will provide us the answers we need.

However, with hindsight from the past 2 or so months, some measures appear to be better than others.

• Social distancing is helping
• Hand hygiene is DEFINITELY helping
• Decongesting hospitals by keeping the mildly symptomatic people away is the wisest of all options.
• Isolating the infected at home, provided they are stable, goes hand-in-hand with the above mentioned measure.

Some things are still in doubt

• Hydroxychloroquine and Azithromycin are not quite the cures people were looking for. Both drugs have their proponents and opponents in equal measure, but there is nothing conclusive in the water.
• Wearing masks is also just as contentious. The CDC is all for it, but the WHO is against it. And being a long time wearer of surgical masks, I am honestly worried about the quality of masks that are currently in the market. The masks are ill-fitting (*I favour the tie-ons to the elastic banded ones), people are not wearing them the right way, and at upto sh. 100 ($1) per disposable mask, people have been recycling them, thus rendering them useless. *In light of current shortages, hoarding and the exploitative prices, I would pray that the government rescinds this order and looks for a more workable solution

Other things don't even need to be mentioned.

• Walking around with disposable gloves all day is one of the most disgusting habits ever. Saw this introduced at Carrefour for shoppers, and the same shoppers proceeded to take those gloves everywhere. This is an infection control failure.
• Police bundling people into crowded vehicles or cells is a plus for COVID-19 all the way. (at the end of this debacle, we are going to need to have a serious conversation as a country about using police officers with zero PR training and comprehension skills, and equally poor demeanors to enforce important government directives)
• Any religious folk claiming they can heal COVID-19 sufferers should be locked up in their lavish abodes and be forbidden from contacting any of their religious faithful. THERE IS NO TIME FOR THIS KIND OF NONSENSE. Tithes can also be humbly directed to the medical efforts or to feed and take care of the less fortunate in society.

There is still a lingering question concerning the low fatality rates occurring in Africa thus far. People might say that we are probably at an early stage of the infection of the populace, and not quite at the "Critical mass" level. I am silently hoping for a genetic/environmental advantage. Realistically speaking though, we need more testing. Initially, we've been doing PCR testing, but eventually we will move on to rapid kit testing. Eventually, we should get to Serology testing where we detect antibodies. At that phase, we'd be able to know patients in the acute phase, and more importantly those who've already developed long term immunity to the virus. Such testing would obviously push our numbers through the roof, but then it would provide another bit of ammo for us in this fight. Let's not forget that plasma from immune individuals could technically be used to confer passive immunity on direly sick COVID-19 individuals as a stop-gap measure until we are able to produce a vaccine.

It has been quite the crazy start to the year, but I'm hopeful that things will get better. I would like to salute all essential staff at this time, particularly the healthcare and allied professionals: the doctors, nurses, physiotherapists, pharmacists, cashiers, cooks, cleaners, etc. This one pandemic will shine a spotlight on an oft-neglected sector, and will become a rallying call for us to fund it and fix it as much as we can. To ignore it any further is tantamount to disaster.

Be safe and God Bless.

The Music of Moonchild: "Little Ghost"

Tracklist

1. Wise Women
2. Too Much to Ask
3. The Other Side
4. Sweet Love
5. Strength
6. Everything I Need
7. Money
8. Nova
9. Get to Know it
10. What You're Doing
11. Come Over
12. Onto Me
13. Whistling
14. Still Wonder

I really gotta hand it to the Youtube algorithm for working extremely well in this specific instance. While scrolling through my Twitter feed, I found out that Anderson .Paak's rendition of "Old Town Road" was generating quite the buzz online. It was quite the wonderful mashup of Lil Nas X's surprise hit with Erykah Badu's "Window Seat" which breathed renewed vigour into a pretty run-of-the-mill song, almost turning it into a classic.

It took me a few days to tear myself away from that song and actually take a look at the adjacent recommendations list which included Moonchild's "What You're Doing". The video's thumbnail only had them silhouetted, so I really didn't know what to make of the group at the time. The song, however, turned out to be very catchy, and they actually turned out to be a Neo-Soul/R&B type group. Another surprise lay in store for me though: during the song, their artful silhouettes occasionally gave way to show the actual singers - 3 of the most soulful CAUCASIANS you could ever run across. This had to be the "Bobby Caldwell" moment for a new generation. In case you might not know it yet, Moonchild consists of 3 multi-instrumentalists: Amber Navran, Andris Mattson and Max Bryk, each being proficient in keyboards, brass (flute, sax, trumpets), and even some strings.

"What You're Doing" is a pretty good taster that highlights the group's R&B credentials, wedged somewhere between late 90s/Early 2000s. Amber's vocals beautifully sail through the song, part whispy, sincere and toned down.(If you ever want to see her echo Erykah Badu, you just might want to check out "Nobody" from Please Rewind).

On this, their 4th studio album, the band's R&B/Neo-Soul roots run through the 14 choice songs laid on track. They made the wonderful choice to have the whole album available on Youtube for everyone to sample. It would be more of an enjoyable experience with the older version of Youtube, but it makes for a jarring experience to be interrupted by ads every so often (how many times can Youtube spam me with the same ads for Safaricom, Grammarly and Colgate toothpaste? Good Lord!)

All the ads notwithstanding,  it feels like there's something for everyone who is R&B inclined. First things first, I've got to get it off my chest that there's some Neo-Soul tracks on here that feel like they're done "For the culture". That's more of a personal gripe for me because I only gravitate towards some Neo-Soul music, but some servings whether they be from Musiq Soulchild, Dwele, Erykah Badu or D'Angelo will just seem a bit overwhelming. For me, those tracks on this album are "Wise Women", "Sweet Love", and "Everything I Need". I'll give the songs a whirl occasionally, but they aren't my go-to tracks.

"Too Much to Ask" is set to a simple sparse beat. Amber's toned vocals make the impassioned plea of the lyrics come alive. This is a lover pining for the better times from her relationship's past, ruing the fact that she's let someone in so close, but still hoping for better times ahead.

"The Other Side" has a sort of bluegrass-y lilt to it, and I'm guessing that's because Andris is playing ukulele on this track. This is another track calling for lovers to rekindle their love, focusing on the foundation already laid down instead of casting glances elsewhere.

"Strength" and "Get to Know it": the lyrics on these two songs currently confuse me. I love listening to Strength, but I can't exactly wrap my mind around what she's talking about. An educated guess would be that she's gathering her strength to pick herself out of the doldrums in a relationship. (Guess I'll be searching for Amber's explanation for the lyrics).

"Money" is a gem of a track that just aims to uplift. Initially, I thought it was Amber's way of showing encouragement to a lover, but on a wider scope it can be applied to everyone from a lover to family to friends. She understands the stresses the person is going through from the weight of expectations and the need to act like they don't need any help; but through it all, she'd bet money on that person and hopes they'd believe in themselves the way she does.

"Nova" is Max Bryk's personal contribution. Clocking in at a paltry 1:05, this can truly be classified as an interlude. However, this is no throw-away cut, but rather a fully realized "New-Jack" head-bobber. I usually give it multiple listens before moving on with the playlist. From the first time I listened to it, I was pretty sure that a nice rap section could be added to it to give it even more juice; and I'm pretty sure that the best person for the job would be none other than "Gift of Gab".

"Come Over" is classic old school R&B. Over a simple catchy beat, Amber plays a seductress/lover-in-waiting who's been afforded the chance to holler at a love interest (who might recently just have become single). She might not be very good at the art of seduction, but at least she's giving it a try, hoping the guy meets her halfway.

"Onto Me" reiterates the same theme from Come Over, but from a different angle; this time it's that of friends who have each other's backs, but want to escalate things to the next level...at least she wants it that way.

I think I'd had a long day at work, such that when I listened to this album the first time I did not get past "Onto Me", which of course turned out to be a big mistake. Just like on their previous Voyager album, Little Ghost's final bookend consists of 2 of the strongest songs on this album. First off, we have "Whistling", which immediately reminded me of Ludwig Göransonn's Grip (from the Creed soundtrack). I believe it's because it's from the same "Trip hop" genre (quite the bit of eclecticism). Clocking in at a mere 2:47, it really is a prime example of short-and-sweet. It focuses on someone who's basically had it; no more time to wait for apologies and is ready to hit the road. Didn't quite think someone could make throwing in the towel sound so nice.

I had that song on repeat for the longest time before I finally moved onto the crowning moment of the whole album: "Still Wonder". There's something magical about the odd time signature of this song that just crept up on me. As soon as I heard it, it felt like an old-school mash up of New Edition*The Gap Band. It has the puppy love nostalgia of Bobby Brown's "Girlfriend", and the subject matter follows a similar vein. Amber croons about all the things she saw in her lover before they even got together, and the love she continues to receive; the chorus then echoes the same sentiment by rhetorically questioning "and you still wonder how I fell for you." To cap off an already great song, they lead us out with a beautiful instrumental section by Max and Andris on the keys; they then  enhance the song with aural perfection by adding a small strings section courtesy of Quartet 405 for the last 2 measures.

The album mostly soars above the rest, and definitely lights up the 2019 R&B scene. Good to see some back-to-basics R&B that is a breath of fresh air. Where the album is exquisite, it soars; and even where it lags, it's still a cut above the rest. I wholeheartedly recommend that you give this album a whirl and sample the beauty of Moonchild's hard work.

Definitely gets an A- from me.

God Bless

Terminator: Dark Fate "Spoiler Free" Review

With this being the sixth installment in the Terminator franchise, I felt that it was important for me to watch it so I could form an objective opinion about this polarizing movie. The trailers have laid out quite the few usual beats for a Terminator movie: a terminator's been sent back into the past to hunt down a target, and similarly, a protector has also been sent after the same target; this sounds like pretty much the synopsis for any Teminator movie, but what makes things slightly different this time around is that Sarah Connor and Arnie's T-800 are also along for the ride.

The talk around town was that this would reboot the continuity thus rewriting Terminator III: Rise of the Machines and Terminator Genisys out of the mythos. This was the same exact move that Terminator Genisys attempted to pull and failed at; this is simply because it would take a singularly innovative and enjoyable movie for that to succeed. Unfortunately, this movie also fails miserably at the same task.

Due to the fact that Terminator Salvation is the only true post-apocalyptic outing in this franchise, I will not really refer to it. Say what you will about Rise of the Machines and Genisys, but they at least added small increments to Terminator lore: Rise of the Machines gave us the T-X, the hybrid metallic core with a polymimetic alloy surface; similarly, Genisys gave us the T-3000 hybrid human and phase matter Terminator, however, it delved further into the T-800s role as a true surrogate father.

This movie actually appears to have taken cues from all aforementioned entries in the franchise, particularly Rise of the Machines and Genisys. They start off the movie by not skipping a beat and immediately changing a basic part of Terminator lore. This is not a "spoiler" review so I will refrain from spoiling the surprise. Suffice it to say, it really doesn't help and it left a sour taste in my mouth from the beginning. From there we get into the regular cat-and-mouse game of finding and protecting the unwitting human, Daniella "Dani" Ramos.

The villainous terminator this time around is the REV-9 portrayed by Gabriel Luna. This is pretty much similar in design to the T-X, with the added advantage that both the metal core and surface alloy can split apart to form 2 independently acting machines. The principal human protector, Grace (portrayed by Mackenzie Davis), is an augmented human whose enhancements come at a bit of a cost.

The only enjoyable thing about watching this was seeing the return of Sarah Connor and Arnie's T-800. Sarah is still the tough-as-nails badass that she established in T2. However, she's grizzled and particularly bitter, far from being the hopeful soul that she was at the end of that movie. She clashes repeatedly with Grace when it comes to protecting Dani. Despite her age, she shows that she's still the capable fighter who'd birth and train humanity's last hope.

It is always a pleasure to see Arnold Schwarzenegger return to this iconic role. The mechanics for this have always existed in the lore, elucidated by Terminator Genisys. Due to the fact that he has living skin draped over his metallic core, the skin (and hair) age and wear away just like normal human skin would; thus he would appear to age just like we would. Also, as an ode to T2, he is capable of learning; in a deleted scene from T2, a function of his memory needed to be switched out of "Read-Only" mode for this to be achieved. They use a different story mechanism this time, but the outcome is the same: he has learnt.

That just leaves us with the rest of the movie. How they managed to serve us the usual Terminator tropes, but to do it in such a miserable fashion is beyond me. Dani Ramos (Natalie Reyes) is the least believable future heroine you will ever encounter (and that's even when you rank her against Emilia Clarke). Mackenzie Davis plays Grace with an angst that makes her seem mostly irreverent and unpleasant. From the story's standpoint it's understandable: she is after all this generation's Kyle Reese. (I remember how unlikable he was when I first watched him onscreen). Just seems a little wasteful for the film makers to take us down this path once again, especially when a lot of that irreverence is aimed towards Sarah Connor.

This is also a very slow story - heavy on set up, but doesn't quite pay off in the end. And for goodness sake, the CGI is a let down. There's some good CGI work here, especially when it comes to de-aging, however, some of the action just doesn't appear weighted in reality. I've been catching occasional clips of T2 on Youtube lately, and even now it's CGI, which was groundbreaking even way back then, still holds up better than a lot of the CGI in this movie. I think wire-work or even a stunt-double could've done a better job when it came to portraying human movement than the CGI doubles.

A lot of people will comment on the fact that this movie will attempt to satisfy the social justice warriors (SJW) concerning the need for a strong female protagonist. I think that director Tim Miller and the producers are misguided in this regard. James Cameron and Linda Hamilton were able to give us one of the strongest female protagonists in Sarah Connor without ever needing to pander to such sentiments. That nostalgia paired with her fortitude still makes an older Sarah Connor as strong a character as ever. For them to try to scuttle that by juxtaposing the story of the Virgin Mary and Sarah's womb in this outing fails miserably. It makes watching the movie that much more jarring, and hopelessly telegraphs Dani's fate. I was not impressed one bit

I came out of this movie angry as hell; angry at myself and I'm not even the one to blame. They have scraped the bottom of the barrel with this movie, and I can definitively say that there is nothing left for them to show us. This outing has effectively killed the soul of this franchise. Never thought I'd find myself saying this, but do yourself a favour and give this one a wide berth. Only worth watching on bootleg DVD. D+ for this one.

God Bless.

P.S: My ranking for movies in this franchise (best to worst) is:

1. T2
2. The Terminator
3. Terminator 3: Rise of the Machines
4. Terminator Salvation
5. Terminator Genisys
6. Terminator: Dark Fate       

IT: Chapter II "Spoiler-Free Review

I actually watched this movie more than 2 weeks ago, but I really haven't been in the mood to review it. This movie just suffered from a serious case of sequel-itis and is one of the few moments that  find myself wishing I'd watched the superior preceding chapter in theaters. This has happened to me twice already this year with "Us" and "Fantastic Beasts: Crimes of Grindelwald". 

All things considered, IT (2017) was an okay movie; it, however, was not the superior experience that most people emphasized that it was. I still feel that the original IT (1990) was actually a more scary experience. Not to take away from Bill Skarsgard's brilliant performance as Pennywise, but Tim Curry's Pennywise is still the superior one in my opinion.

The second part of both IT iterations tend to follow the same beats: less Pennywise and less interesting/scary than their predecessors. This is more evident in IT: Chapter II. The movie is extremely long and drawn out. It makes sense in the beginning because it needs to re-introduce us to the grown version of the protagonists (The Losers' Club); but it just slows down somewhere in the middle, and it just becomes this sort of unfulfilling slow-burn.

Most of the adult characters are believable versions of their teenage counterparts; the casting department deserves a lot of respect for their casting choices, especially for the Bill Hader/James Ransone rendition of Richie and Eddie combo. I'm guessing that what lets us down is the adaptation of this Stephen King book for the big screen. Despite how far we've come technologically (yeah, the IT: 1990's underwhelming version of a Spider monster was a real letdown), this movie really struggles to get me to believe that the clown evokes as much fear in the adults as he did when they were kids. A big part of this is due to the use of computer generated imagery (CGI) where practical effects would have sufficed; the CGI is so obvious that it just pulls you out of your suspension of disbelief. If I wasn't so disappointed, I would have laughed out in some of the areas that were meant to cause scares.

The CGI actually gets irritating in places because it cause an "Uncanny Valley" effect. I can understand that the child actors grew considerably since the filming of the last movie, but there are a few notable areas in the movie where you can see the wonky effect of CGI on Eddie (Jack Dylan Grazer) and Ben (Jeremy Ray Taylor).

The character of Henry Bowers also feels really wasted this time around. Implausibly, he resurfaces after that death-defying fall down the well in the previous installment, and reappears as an adult to wreak havoc. Teach Grant plays adult Henry as someone who's insane, but he just doesn't seem like that much of a menacing character.

All this eventually leads to a final act that seems more stuffed with overkill than John Wick: Chapter 3. Initial scares followed by a plot twist, then solo scares and more teamfare just makes this a painful slog until the end. One of the more touching moments in the movie is that of the team comforting a crying Richie, but that's the only saving grace in a long joyless affair.

If I were you, I'd wait for this when it comes out on DVD/Blu-Ray if you really feel you must watch it.  Definitely give this movie a well deserved B-/C+.

God Bless

Cholera: A Sign of Things to Come

I remember a time during one of my (Messiah) college Bio classes helmed by Dr. Jon Makowski. I believe we had gotten to learning about faecal coliforms - indicator organisms that basically indicate faecal contamination of water sources - and he posed a basic question at the end of one lesson which would be addressed at the start of the next lesson:

"What is the acceptable amount of coliform bacteria (Colony forming units, CFUs) in water meant for drinking?"

I remember having to scour my books looking for the answer. My internet searches were similarly difficult; this was in Pre-Google days, so I was mostly checking for my answers on Ask.com. I remember glimpsing an article that listed the answer summarily as "zero" without much explanation, but I also came across something that gave some leeway for CFUs in recreational water sources.

True to form, Dr. Makowski started the next lesson with the same question. Varied answers were given, but none of them was right. Without much trust in my answer, I told him "Zero."

"Correct," he answered. He then proceeded to give us a very simple analogy:

"If I took a speck of stool and mixed it into a glass of water, would you drink it?" 
"Of course not!" came the general class answer.
"What if I dilute one drop from that glass into another glass of clean water?"
"Still No!" the class answered.

Despite the promise of even more serial dilution, no one would accept the challenge of drinking the water. His point was clearly made. It didn't matter how much water was used to dilute that water containing the coliform bacteria; no one in their right mind would consciously consume such water. And thus go the standards for our drinkable water. None of the intestinal bacteria (indicative of the presence of possibly more dastardly organisms in our water) is meant to be detected in our drinking water.

My mind alluded back to this memory in light of the current cholera shenanigans we are facing in Kenya. A work colleague doesn't mince his words when talking about cholera when he's talking to patients about it:

"you've basically got to let them know that they've come into intimate contact with shit!" (pardon the expression)

I am a bit more diplomatic about it and I'll talk about (faecal) contamination of consumed food or water.


Cholera always used to be thought of as a disease for the poor and disadvantaged, living in their hovel abodes with poor sanitation. However, 2017 appears to be the year that things changed: first, came the cholera outbreak at a posh wedding ceremony in the upmarket Karen area; then there was the outbreak at Weston Hotel which ironically affected a medical practitioners' conference, and saw many a doctor (both domestic and international) hospitalized due to the disease; and last, but not least, there was the outbreak at a trade fair at the Kenyatta International Conference Centre (KICC), which saw two Cabinet Secretaries and one Permanent Secretary affected by the infection. A lot of people forget that our very own President opened the fair and was potentially meant to have dined on the food at the same area. The food vendor for the occasion is a prominently known hotel, but it is only discussed in hushed tones lest anyone experience any blowback.

I have dealt with my fair share of Gastroenteritis (GE) at the clinic lately; that's the technical term for conditions that affect the stomach and the intestines, which ultimately yield vomiting and diarrhoea. (technically clinicians may sometimes refer to conditions causing diarrhoea as GE). Gastritis (stomach inflammation) and Enteritis (intestinal inflammation) also exist as different entities, and yes, my colleagues and I have had to treat that too. The strange thing is that it is now very common for me to request an accompanying cholera antigen stool test. As is the norm now, a lot of my patients are middle to upper class individuals, and the reality is that their status will not confer upon them any sort of special favours when it comes to cholera.  

People seem to think that it is strange for me to test them for Cholera, especially if they were able to walk themselves into the clinic; the image of a person laid out by the disease and knocking at death's door is what they seem to cling to; however, as with many disease conditions, there are grades to this condition. I have had many a patient walk into the clinic with a mild case of food poisoning, sometimes so mild that they wouldn't even mind returning to their offices afterwards. When the Cholera antigen test comes back POSITIVE, they seem to think that I'm messing with them. That becomes a good teaching point for the fact that a cholera infection is actually dose-dependent: the more of the bacteria that you ingest, the worse your infection is likely to be. Also deserving of special mention is the people who are using antacids; lowering your stomach acidity, while making you feel comfortable will also reduce your stomach's ability to deactivate certain types of harmful bacteria. Thus you can have all levels of cholera sufferers ranging from the mildly inconvenienced to the dastardly ill requiring intensive care.
 
But how could it be that we've fallen this far where a disease like cholera is fair game for every one in the land? It should be child's play dealing with cholera because we know how it's spread and thus how we can keep it at bay. I surmise that a couple of factors are key.

1. Sprawl - I pass through some areas in Nairobi, and I'm taken aback by just how much has sprung up in terms of new developments. Areas that used to consist of well built bungalows were replaced with high-rise buildings as the bungalows of yore were brought down en masse. People might see this as a mark of progress, but to me it merely spells disaster: sewer lines have not been upgraded to keep up with the pace of construction, and other people may opt to set up septic tanks that are ill-equipped to deal with the demands placed by their inhabitants. And in case anyone forgot, WATER is a finite resource that keeps getting more scarce by the day.
2. Clean Water Trucks - with the water shortages suffered on a regular basis (some of them actually orchestrated by unscrupulous individuals for material gain), these trucks have been making quite the profit. However, it is a slippery slope with this vastly unregulated sector: what is the source of their water, and what is the level of cleanliness in those tanks that are used for storing and transporting the water?
3. Poor surveillance and enforcement - seems to me that we have so many government bodies in charge of everything under the sun, but the typical Kenyan citizen gets burned by everything that those aforementioned bodies are meant to be protecting us from. NEMA (The National Environmental Management Authority) is probably one of the more useless ones. Despite the major cholera outbreak in 2017, they spent that time patting themselves on the back for chasing down the infinitely less important "plastics issue". They practically made Kenyans feel like criminals for walking around with plastic bags, but they dragged their feet about dealing with folks openly discharging untreated waste into water sources.

I feel that the last two might be particularly intertwined. Lately, while driving along Ngong Road - at the point after Westwood - I have been seeing  a water truck parked right next to the edge of the Mbagathi River. Granted, there used to be car washing services occurring in that general vicinity, but the vehicles were never parked at the river's edge. I think that those trucks are pumping in water directly from the Mbagathi River.
This shouldn't be such a bad thing until you consider the situation upstream of Mbagathi River. A stream which eventually drains into Mbagathi starts out around the Mathare slum area of Ngong Town; by the time the stream makes its way down to the Zambia Road vicinity, it literally consists of black water. The stench is unbearable, the water is murky and turbid. It is obvious that raw effluent is making its way into the water from houses adjacent to the river (and a clinic, if rumours turn out to be true). This water is what will eventually make its way into the Mbagathi River, and even the Nairobi River downstream.

There is room for dilution of the black water as it joins the Mbagathi River; but in much the same way that my Bio teacher couldn't get us to drink water that contained a serially diluted amount of fecal matter, I don't think anyone should conscientiously consider using that water for anything.

Now, I will note that I have seen a similar looking truck (with a white tanker) being used to spread water on the Lang'ata Road expansion occurring in the Karen area. But it isn't a stretch to consider that the same truck might dabble in being used to transport potable water to people.

NEMA should be at the forefront of sorting this issue out, but I have very little hope in the people of NEMA, from personal experience. My family used to live adjacent to a compound that consisted of many houses, but all their waste drained into one septic tank. Now, the landlord was not in the habit of emptying that septic tank, and, periodically, it would overflow into our compound. My mother brought this to the attention of the relevant NEMA individual in-charge, and he came to assess the situation on the ground. Threats were issued to the offending party, but it soon became pretty clear that bribes laid the issue to rest.

The sad thing is that I'm pretty sure ours was not a one-off experience. Perhaps that man would have acted differently if he'd had to deal with a cholera sufferer. We had a patient come into the clinic some time ago who was cold to touch, had low blood pressure and was incoherent. She was bone dry and her kidneys had started to shut down from severe dehydration. That patient practically brought our well-staffed clinic to a standstill as we struggled to resuscitate her and we eventually ended up sending her straight to the ICU. I think anything less in terms of management would have been a death sentence for her. It ended up being a rough week for her, but she survived.

We cannot sit down and pretend that this issue does not exist. The solutions are simple, but they will require dogged stubbornness and resolve to make sure that they are followed to the letter. We are all at risk, and we need to prepare for the worst. Our personal vigilance needs to be bolstered by proper surveillance and enforcement by all the relevant statutory bodies otherwise our own efforts would be for naught.

Be vigilant.

God Bless

The Music of James Ingram: Always You

Track List:

1. "Someone Like You"
2. "Let Me Love You This Way"
3. "Always You"
4. "Treat Her Right"
5. "A Baby's Born"
6. "This is the Night"
7. "You Never Know What You Got"
8. "Too Much for this Heart"
9. "Sing for the Children"
10. "Any Kind of Love"

I knew I would eventually get the nerve to review this very formative record. I didn't expect that Mr. Ingram would've passed as abruptly as he did, but thankfully the spirit of his music and the influence he cast over us all remains in our lives.

"Always You" is an album I encountered because my Dad would play it in the car's stereo as he drove us - my twin brother and I - to (primary) school. My introduction to Mr. Ingram's music actually came through my two eldest siblings. I remember my brother playing "Call on Me" a few times in the house from his "It's Real" album (1989 release). I can also recall my sister playing Quincy Jones' "Secret Garden", which also coincidentally came out in 1989. I must admit, when I was a youngster the "Sweet Seduction Suite" didn't mean much to me; however, when I grew up a bit and learned to appreciate grown folks' music, then I finally started to appreciate the massive collaboration that made the Secret Garden such a success.

Anyways, back to circa '93. The only single released off this album was track number 1, "Someone Like You". I recall being surprised to hear it blaring in a big chain supermarket down in Kisii during my internship (2014). I remember thinking to myself that something was right with the world if such a song was getting airplay. The song is classic James in its melody and structure; in it we find him crooning about yearning to possess the object of his affection.

It really is a shame that more of the album isn't more well known because it really is a total package. The songs are mostly ballads (7 out of 10), but then he slipped in 3 songs that are anthemic, odes to specific aspects of humanity ("A Baby's Born", "Sing for the Children", and "Any Kind of Love").

Things slow down a bit on Track 2 - "Let Me Love You This Way"; this fittingly feels like a sequel to "Someone Like You". Here he's a man in love who's trying to figure out how to express his love to his significant other. He dabbles with the idea of promising and achieving impossible or improbable things, but in the end he resolves that the simplistic act of being "by her side always" is what counts the most.

(The series of songs from Track 3 - 6 are what I consider the simply unskippable portion of the album)

"Always You" takes us on a different kind of musical journey - that of heartbreak. He calls back to yesterday, a time filled with shared dreams and nascent love; he contrasts that with the stark reality of today where he clings to the memory of his "love" despite things having come to an end. He still holds out hope that things can work out for the better and that he'd have a chance to reunite with his true love. This is a really melancholic song, and the chimes always makes it feel like he's reminiscing about this during the holiday season. Backed most prominently by an organ, he lays out his heart and longing in perhaps his most emotional song on this album. 


"Treat Her Right" finds him admonishing a 'brother' who is unable to appreciate a wonderful lady in his life. He extols all her virtue in detail, and contrasts it with the little that she needs from her man. Feels like he took it to church with this track.  

"A Baby's Born" is an ode to life. In it, he reflects on time, the changing of the seasons, life drifting forward, getting old and having old friends pass away; at the end of it all, this is contrasted with the gift that yet another baby will be born. This song really only consists of one poignant verse presented against operatic instrumentation. The latter part of the song is a real feast as we have James sound off his falsetto vocalization in turn with the chords of a guitarist's solo. Truly a feast.
*I hadn't known that this was a cover song until just recently. It was originally performed by Johnny Mathis in 1973. The  original instrumentation sounds quite "Bacharach-ian" with a hint of motown (perhaps more Bacharach inspired than Ingram's version). This version puts a new spin on things, but both versions are quite enjoyable.

"This is The Night" has always been my favourite song on the album. I literally didn't know that (the great) Burt Bacharach had a hand in crafting this gem until I checked the album's wiki page, and confirmed it in the liner notes. This ballad describes a man's transition from a forlorn soul to an actualized individual once he finds the love of his life. In my mind I always pictured this as the perfect wedding song (right up there with Patti Labelle's "If Only You Knew", Minnie Ripperton's "Loving You" and Julie Fowlis' "Tha Mo Ghaol Air Aird a' Chuan"). The tape version I initially heard, unfortunately, lacked the keyboard and strings intro, instead starting straight off with the harmonized humming, but I'm glad I got it on the CD version. The intro consists of two identical runs of booming organ notes that initially seem to hint at nothing in particular, then the strings join in to lay out the rhythm that characterizes the start of each verse; then that magical humming comes in and is accompanied by an aggressive electrical guitar riff. Set against a deep pulsing bass line, he proceeds to lay down 5:05 of perfection.   

"You Never Know What You Got" turns the spotlight on the lady (in the relationship) for a change. It reflects on the ups-and-downs of a relationship, with him emphasizing that she stay in the relationship lest she be left all alone sitting by the phone. Despite his already self-appreciated limitations, he promises to do the best he can by her; the flipside is for her to abandon the relationship, and risk not having something to return to.

"Too Much for this Heart". After the heartbreak comes the chance for yet another attempt at love. This song, however, addresses the doubt that someone feels at putting themselves out there again for a chance to find love. The trepidation is on full display here.

"Sing for the Children". Of the two Bacharach contributions, this is the more classic Bacharach outing - the orchestration at the start of the song is evidence of that (the horn arrangement). This ode to children calls for the preservation of their innocence, for their need to feel love. In the second verse, he focuses on the memory of his deceased father, a balancing influence that still gives his life purpose; this is the kind of influence he wants for all children, which would be a saving grace for both their dreams and humanity in general.

"Any Kind of Love" is is an ode to good old fashioned humanity, which plays out like a blast from the past. James and his crew are literally jamming for the whole first minute in a 6:55 song. It's not until we get to the 1:28 mark that he finally starts to lay down some vocals. The song is a heartfelt call for us to share some love for the sake of our fellow men. The breakdown at the end is more jamming magic clocking in at another minute.

I remember picking up my own CD copy of this album at a discount store in Capitola, CA, and it really is one that I treasure. Good wholesome music that's beautifully crafted and has aged very well. I've always been impressed by his signature hallmark - "Ingram howl" - that he belts out so effortlessly, and as always it'll appear on a couple of these songs. If you do have a chance to listen to this album (I believe all songs are available on Youtube), by all means do it. It is wonderful. 


Rest in Peace Mr. Ingram.

God Bless.