Carol for the absent

Polish tradition says that an extra place should always be set at the Christmas Eve table for the absent or the needy. It was always a time to welcome people into our home. Very often, when I was growing up, these were foreign students a long way from home. This morning, I found a carol that addresses the empty seats at the table. Those we have loved and lost:

http://spuscizna.org/music/k-absent.html

This evening, my family will be joining other relatives for a Christmas Eve dinner. There will be empty seats for those we have lost.

WWIII?

Seventy five years ago, on September 1, 1939, World War II began with the invasion of Poland. Seventeen days later, the Soviets invaded from the east. Appeasement had not worked to contain Hitler in his quest to dominate Europe. It only encouraged him to become bolder in his land grabs. And in the abuse and murder of people in the occupied lands.

Once again, there have been years of appeasement, which seem to be emboldening another leader. Thirteen years ago was the second Chechyn war was underway (http://www.telegraph.co.uk/news/worldnews/vladimir-putin/10679121/Ukraine-crisis-We-confront-Vladimir-Putin-now-yet-appeased-him-before.html). The, in 2008, Russia tried to take over Georgia and succeeded in controlling a part of the country (http://www.washingtonpost.com/opinions/mikheil-saakashvili-the-west-must-not-appease-putin/2014/03/06/db9e0c82-a4a9-11e3-8466-d34c451760b9_story.html). Similarly there has been a separatist part in Moldova which has been supported by Russia. And then, annexation of Crimea. And now, a war in Ukraine.

Like the expansions of Germany in the 1930s, where Hitler argued that he needed to protect ethnic Germans in the annexed parts of neighboring countries, Putin argues that these expansions have been to protect Russian speaking populations in those countries. All of the countries which were part of the former Soviet Union have significant Russian speaking populations. And similar to the Anschluss, when Austria was annexed to Germany, Putin has said that Ukraine is not a separate nation (https://www.youtube.com/watch?v=k410KneBpbY). Putin has also said that the fall of the Soviet Union was one of the major tragedies of the twentieth century. 

It appears that the former KGB agent wishes to restore the Soviet Union. And, so far, the world has allowed him to work toward this aim, imposing only economic sanctions for the support of the separatists in eastern Ukraine. Nevertheless, until recently, Russia denied that it was supporting the separatists. Until it became apparent that Ukraine was regaining territory that had been controlled by the separatists.

Then, nearly seventy five years to the day after the start of WWII, while many in the US were enjoying the start of their Labor Day weekend (which was placed in September to separate it from the May Day celebrations of labor in much of the rest of the world, including, especially communist countries), Russia invaded Ukraine. This was south of where most of separatist activity has been. Yet, he calls these troops "volunteers." "Volunteers" with tanks--two columns of tanks. 15,000 Russian troops are now reported to be in Ukraine (https://www.youtube.com/watch?v=OSUeewx4qL8).

The Russians have routed Ukrainian forces in several areas and have begun arresting Ukrainians in areas they took over and deporting them to unknown locations (http://wiadomosci.gazeta.pl/wiadomosci/1,114881,16542864,Jaceniuk__Putin_rozpoczal_wojne_w_Europie__chcemy.html?entry=1231554#MT). In addition, they fired on Ukrainians leaving an area in which they were previously encircled via a "safe" corridor.

And, to discourage other nations from supporting Ukraine, Putin reminded the world over the weekend that Russia is a "nuclear superpower." (http://www.ibtimes.co.in/putin-warns-west-we-are-nuclear-superpower-dont-mess-us-607925) He has also begun referring to the area in eastern and southern Ukraine as "Novorossiya," a term which was used in the time of Catherine the Great.

Similarly, as Kazakhstan has expressed more nationalistic sentiments, especially regarding the space launch facility which Russia rents from them, Putin has warned them that they may be next in his efforts to reconstitute the Soviet Union (http://hotair.com/archives/2014/08/29/putin-youre-next-kazakhstan/). But, these countries are not falling into line as Putin might have expected (http://belarusdigest.com/story/belarus-ukraine-and-kazakhstan-building-alliances-against-moscow-15829). Rather they are starting to form alliances against Russia. 

While the West is not obliged to come to the defense of any of these countries, the Baltic nations of Lithuania, Latvia and Estonia, as well as most of the countries of what once was communist controlled Eastern Europe, are members of NATO. NATO has been shoring up its support of its easternmost members since it realized that it was in a poor position to defend them should they be attacked from the east (http://www.newrepublic.com/article/116967/nato-no-position-protect-eastern-europe-russia). Here, too, appeasement was in play in 2009, when the US backed down on a missile shield defence for Poland.

In addition, the restrictions on food imports, imposed by Russia in reaction to economic sanctions imposed by the West for the Russian support of separatists in eastern Ukraine, are punishing average Russians with increasing food prices (http://www.bbc.com/news/world-europe-28849726). These could drive Russians to lose support for their government, especially its territorial claims, or could increase solidarity against the world, as shortages did for the Russians under previous rulers.

So, now, we have a Russia, emboldened by appeasement which is threatening NATO members with nuclear attack should they dare oppose Putin's plan for reconstituting the Soviet Union. And, already, it is apparent that Russia will continue on its expansionist path, regardless of the desire for peace by the leaders of the West (http://www.forbes.com/sites/marcelmichelson/2014/08/29/it-is-time-to-face-it-we-are-at-war-with-russia/). 

So now, we are faced with the decision, as put succinctly by Ben Judah, to Arm Ukraine or Surrender (http://www.nytimes.com/2014/09/01/opinion/arm-ukraine-or-surrender.html?_r=0). The world must decide whether Russia will become the dominant power on the Eurasian landmass or the West will draw a "line in the sand" or, in this case, the fields of Ukraine. Neither path will be easy for the world. 

Warsaw Uprising

Seventy years ago, on August 1, the Warsaw Uprising began. It was the largest military effort by a resistance group. It has been said that more Jews fought in the Warsaw Uprising of 1944 than in the Ghetto Uprising of 1943.

The Polish fighters were so effective that the Germans began to retreat, especially as they saw the Soviet Red Army nearing Warsaw.  Once they realized the Soviets would not come to the aid of the Poles, the Germans regrouped and defeated the outgunned Poles. The Germans began systematic massacres of civilians. By the end of the Uprising 200,000 civilians had been killed. Forty thousand were killed on August 8 in the Wola Massacre alone. Another 50,000 are said to have fled. Over eighty percent of the city was leveled.

Yet the Warsaw Uprising was carried out with limited outside support. Only one American airdrop of supplies was allowed by the Soviets. The Polish pilots with the British Air Force were too far away in Italy. Nevertheless, the British made over 200 flights to help the Polish Home Army in 1943 and 1944. When a British mission did finally arrive in December, to help the Poles in Warsaw, they were promptly arrested and imprisoned by the Soviets.

On August 15, the same Soviet Foreign Minister Vyacheslav Molotov sent an emissary to inform American Ambassador Averell Harriman that the Soviets would not support the Poles. So, the Red Army was waiting for resupply across the Vistula river, as they watched the city burn.

There was only one attempt at providing help to the Polish insurgents allowed. It was made by Poles serving under General Zygmunt Berling in the Red Army.  Many of these men were taken prisoner in 1939-1940 under the terms of the Molotov Ribbentrop Pact and spent two years in gulags. They were freed only after the Germans reneged on the agreement and invaded Soviet territory in July, 1941, when they actually invaded the eastern part of Poland previously ceded to the Soviets. After that point, the Soviets needed soldiers and freed the Polish prisoners. Some made it out with the Anders Army under British command, while others were too late to join General Wladyslaw Anders and then joined the Berling Army in the hopes of liberating their homeland.

The Soviets gave orders on August 23 not to help the Poles, rather the arrest and disarm them. The attempt to help the Poles in Warsaw occurred on September 14. Only 900-1200 made it across the river. There was no artillery or air support provided. No further attempts were made after September 19. General Berling was relieved of his command and ordered to return to Moscow, perhaps for his disobedience in this matter.

Even with the limited outside support, the Poles continued to fight until October 2, when they finally surrendered. The Uprising had lasted 63 days. The combatants were taken as prisoners of war, since it was felt that they fought as an organized military unit. Even the women combatants were given that distinction. Earlier, even Polish soldiers were deemed "bandits" since they served a country which the Germans felt did not exist since 1939, after the joint invasions from the west by the Germans on September 1, 1939 and the east by the Soviets on September 17, 1939. The two powers had divided Poland in accordance with the Molotov Ribbentrop Pact of August, 1939.

During the years of communism, the history of the Warsaw Uprising was suppressed by the Soviets, who painted the partisans of the Home Army as Nazi sympathizers, despite the fact that they were the largest resistance movement in Europe. For years after the war, they arrested, imprisoned and often executed former members of the Home Army. Since the fall of communism, this history is again remembered.

Photo courtesy "Sąd najwyższy s5" by Spens03 - Own work. Licensed under Creative Commons Attribution-Share Alike 3.0 via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:S%C4%85d_najwy%C5%BCszy_s5.jpg#mediaviewer/File:S%C4%85d_najwy%C5%BCszy_s5.jpg

The intersection of medicine and war

Had another blog published on Physicians Practice:
http://www.physicianspractice.com/blog/when-war-and-medicine-combine-physician-reflects

Things continue to heat up

Reading the news about Ukraine continues to scare me. The countries of the victims of MH17 send more police and even troops to help with the investigation. It was revealed that the man who likely fired the rocket that downed the passenger plane (http://www.ibtimes.co.uk/igor-strelkov-key-mh17-crash-suspect-linked-massacre-3000-bosnian-muslims-1992-1458304) is a veteran of both the Soviet and Russian armies, and is thought to be a covert agent of Russian military intelligence (GRU).

Russia is moving more powerful weapons close to the border. It may also be delivering more powerful weapons to the separatists. US intelligence is reporting that rockets are being fired from within Russia across the border into Ukraine.

NATO is placing more troops in Poland (http://rt.com/news/175292-nato-poland-supply-base/). Poland is buying more weapons, as it and the Baltic countries are increasingly concerned that, despite being members of NATO, the alliance will be reluctant to engage Russia in their defence. Those in Brussels have acknowledged that defence of the eastern countries now in NATO would be difficult. Perhaps that is the reason for the new base being proposed in Poland.

Even as I watch from the comparative safety of the US, I remember that a Russian AWACS plane flying along the coast interfered with air traffic control at LAX. The world is now not that big. Regional conflicts can spread quite quickly.

The Russian bear seems to be wanting to reclaim the territory it lost in "the worst disaster of the twentieth century," as Putin described the breakup of the Soviet Union. It is nearly the 75th anniversary of the start of World War II, as the Germans and the Soviets invaded and divided Poland under the Molotov-Ribbentrop Pact. I hope that we are not seeing the lead up to World War III.

IPPNW weighs in

Since my last two blogs have dealt with Ukraine, here is IPPNW's opinion:
http://peaceandhealthblog.com/2014/07/22/crisis-in-ukraine/

Medicine and War

War and medicine have always been linked. Surgical instruments are often developed by military surgeons--Army/Navy retractors, Russian forceps, Jackson-Pratt drains, external fixators, to name just a few of the instruments developed by military surgeons. Sometimes this is obvious by the name, sometimes not. But war has helped with the development of medicine, as medicine has struggled to cope with the devastation of war. And physicians have at times been involved in development of "better ways to kill."

I have never been in a war. The closest I have come was working in inner city hospitals while drug cartels were fighting for "turf." But, I could return home to the safety of a middle class community where shootings were rare. Nevertheless, I have worked with Physicians for Social Responsibility and EMERGENCY to try to help prevent war and care for the civilian victims of war.

Tonight, as I learned more about the Malaysian Airlines jet shot down in Ukraine, I learned that there were 41 war zones around the world. Forty-one. The number surprises me and yet it does not. I know that we have always been a violent species. Perhaps, this is a typical number.

Tonight, I learned of another way war has affected medicine. One hundred AIDS researchers were killed in Malaysian Airlines jet shot down over Ukraine.(http://www.medscape.com/viewarticle/828523 and http://thinkprogress.org/health/2014/07/18/3461625/aids-experts-malaysian-plane/) Usually, medical researchers spend much of their time in academic settings, being exposed only to the violence and drug use of the inner city. Perhaps some of the researchers studied people in less developed parts of the world. Even so, they likely thought that they were heading to a convention in a peaceful part of the world, Australia. They may have even been bringing their families, evidenced by many children on the flight. They likely had taken many flights before, and so were not worried about the risks of flying.

The passengers were likely watching a movie, reviewing notes on a computer or sleeping as the plane flew at 30,000 feet. They didn't think about what they were flying over. So many war zones between the Netherlands and Malaysia. Passenger planes surely avoid the major war zones. Few of the passengers thought of the risk, until it happened. Until a passenger jet was shot from the sky.

It may have been a case of mistaken identity. Even so, the shooting down of the Malaysian Airlines jet over Ukraine may have an effect on the health of the world's citizens for years to come.

Ukraine and the Budapest Memorandum

What does violation of the Budapest Memorandum mean for the future of nuclear non proliferation and arms reduction?

As the war in Ukraine becomes more obvious to those who have not been following the situation with the downing of the Malaysian jet with the loss of 295 civilian lives, people who were uninvolved in this conflict, I feel that I need to bring up some of the other issues that I see. This is now a regional war, not even involving the territory of a whole country, but the risks extend much further.

In 1994, Ukraine, together with Russia, the United States and United Kingdom signed the Budapest Memorandum. It guaranteed the territorial integrity and political independence of Ukraine in return for signing over the nuclear weapons in its possession to Russia. Later, this was expanded to include France, China as guarantors, and Belarus and Kazakhstan along with Ukraine as nations that would give up their nuclear weapons.  Since, the launch codes for many of these warheads were kept in Moscow, the weapons in Ukraine, Kazakhstan and Belarus were really not under the control of the respective governments. In this sense, the transfer was perhaps less significant. Nevertheless, it was the first time that governments gave up nuclear weapons for the promise of peace.

More recently, with the expansion of the European Union and NATO into formerly communist countries of East Central Europe and even into the Baltic countries, which were part of the Soviet Union after World War II, Moscow has expressed concern about western interference. Similarly, it has felt pressure from the south, both in terms of Islamic influence in the republics with large Muslim populations, and with American bases being placed in some of these countries to support the wars in Afghanistan and Iraq. To counter the European Union’s trade benefits, Russia has proposed a Eurasian Union including Russia, Ukraine, Belarus and Kazakhstan as the core.

But, some former republics wanted more change. First there were the Chechen wars of 1991 to 1994 and 1999 to 2000 and the ongoing Chechen terrorist attacks and suppression in Chechnya. And more recently the Maidan movement in Ukraine. Due to both the size and historical significance of Ukraine to Russia, this was a blow to heart. Propaganda has been intense on both sides. Finally, Russia took over the Crimean peninsula and parts of eastern Ukraine are still being contested.

Russian annexation of Crimea is a clear violation of Ukraine’s territorial integrity making this a violation of the Budapest Memorandum. It is clear why Russia has not come to the aid of Ukraine. But, while both the US and UK issued statements and applied political and economic pressure, what more could they do? After all, Russia was on the other side and the possibility of war with Russia is something they want to avoid. Once again, those in former communist dominated countries feel they are again being sacrificed to political expediency.
Clearly, as Ira Helfand said in his May editorial (http://www.desmoinesregister.com/story/opinion/columnists/2014/05/04/another-view-ukraine-crisis-danger-nuclear-war/8665185/), nuclear war would be disastrous for the planet. A nuclear war between the United States and Russia, once again a possibility, is something we must avoid.But, are there other concerns in the Ukraine crisis? Does a nuclear power have the right to attack or annex a non-nuclear one simply because of the fear of nuclear war? This precedent is very disturbing. Just as when the US invaded Iraq a decade ago in search of weapons of mass destruction, while it did little about the real nuclear weapons in North Korea. Comments were made then that possession of nuclear weapons was protective. Not exactly the message we should want to send if we want nuclear disarmament. Now, again with the annexation of Crimea and further incursions into Ukraine’s territory, we again have a situation that appears to demonstrate that not having nuclear weapons, this time by giving them up, makes a country vulnerable. How can we convince these countries that the path to peace and security is through eschewing such weapons rather than by building more?

And, what is the impact of violation of the Budapest Memorandum on the behavior of smaller nuclear or near nuclear states? There was a multilateral agreement guaranteeing the territorial security and freedom from external influence protecting Ukraine. How can the larger nuclear nations be trusted when they offer security to a smaller nation again? What of other multinational agreements?

Other questions also arise? Are some people expendable? This has been a concern for half a century as the great powers have fought their wars through surrogates. Most of these people had dark skin and died so the great powers did not fight directly. Now again, the question arises in relation to those who live in proximity to Russia, and who remember, through their grandparents, the massive population destruction and relocation of the Second World War, its precursor Holodomor in the Ukraine and the aftermath of World War Two under communism. Timothy Snyder called this region “Bloodlands” since so many people died in the area of Ukraine, Poland and Belarus before and during the Second World War as Germany and the Soviets first divided then fought over this land. These memories are also causing Poland to lead pressure on the West and its guarantees to newer members of NATO and the EU. Poland remembers both the lack of help, despite treaty agreements, in 1939 from Britain and France, and the Yalta agreement which relocated it, and many of its people to the west, yet gave the Soviets control of its government. As a result, NATO is putting more troops and weaponry in Poland and the Baltic countries, and carrying out war games in the region. While this is very understandable, it further enflames the situation.

So how are those of us in the peace community to reconcile these issues? It isn’t easy. So far, the world has chosen appeasement, in essence encouraging Ukraine not to fight Russia. But is appeasement the right answer? But how can we change this path without taking to task one of the world’s largest nuclear powers? And what would that choice mean for the world? What does that choice mean for the people of Ukraine and Eastern and Central Europe?

How do we convince countries considering nuclear weapons not to develop them? So many of the messages of the past decade seem to suggest that a country is safer with nuclear weapons than without. We are sending the wrong message. I worry that more countries will embark on the course toward developing nuclear weapons, and this will also increase the risk of nuclear war in the future.

I find that reviewing this situation has left me with far more questions than answers. And more concern for the future of the world.

Monte Cassino

Today is the 70th anniversary of the Battle of Monte Cassino. The Polish Forces under General Władysław  Anders finally succeeded in taking the mountain topped by a monastery. One thousand fifty two Polish soldiers died in the battle.

 

My mother's step brother fought in that battle. He was not yet 16. He had been taken from his home together with his family in 1940 by the Soviets. His grandparents were simply killed. They were dropped off in a frozen forest. They asked, "Where do we live?" only to be told, "There are trees, you can build houses." They had brought no tools to cut down the trees.

They asked, "What do we eat?" The answer was similar, "There are rabbits." Yet somehow a few survived. His brother, who was 3 when he was taken, was "too young to live." His father also died before making it to freedom.

Yet my uncle and his mother, who married my widowed grandfather, did. And my uncle then joined the General Anders army, even though he was under aged. He stayed in the British army after the war and was in one of the last units to leave Palestine before it became Israel. He later was sent to Korea. Meanwhile his mother came to the US via Mexico.  He then left the British army to join the American army, spending additional time in Korea, and then going on to teach at the Monterey language school.

Still a young man, he used his GI bill benefits to complete his education and became an electrical engineer.

He and my mother were close until her untimely death. She always loved poppies. We had hundreds in our yard.

Slavery today, here in the US

As a physician, I can't even count all the times that I saw an injured worker who came in with two or more employer representatives. Most of the time, I am sure this is simply out of concern, but sometimes it may not be innocuous. Sometimes that injured worker is held as a slave and the others with him are there to make sure he doesn't tell anyone of the conditions he works under. This is a new realization for me.

Not long ago, I read the book, "The Slave Next Door," by Kevin Bales and Ron Soodalter, and began to realize that sometimes things aren't so innocuous, even here in the US. I had heard about the sex trafficking of minors, garment sweatshops in LA and tomato growers in Florida, but never thought that a slave might be sitting in front of me. I now have gained awareness of this situation, but still don't know how to approach such a patient. 

Image not available

 

Clearly, one can't ask in front of the employers. One must make up a pretext for privacy and have a hospital employed interpreter if necessary. The employer supplied interpreter may be yet another guard. The reason for privacy could be the need to do a pelvic (for appropriate specialties) or rectal examination.  Then, I have sometimes asked, as I do when I suspect a battered wife, "Are you safe? Are you OK? Anything you want to tell me? Anything else you want me to help you with?" but have not yet gotten a response of someone asking for help in such a situation. (I have had battered women and teens tell me they need help.)

Yet, I know that one must be aware of a pathology before one can identify it, whether it is a disease of the body or of the culture. I can see my awareness growing, in that I now suspect it, even when simply reading the medical records where it is stated that "two employers and the employer's interpreter" came with the patient. It also gives me the greatest reason to need a hospital or clinic employed interpreter, or phone service.

It is necessary for physicians to become aware of the problem so that there is a chance of recognizing and addressing it.

Mother's Day

My mother was a very generous woman. I remember that she was always helping others. When I was small, she was very involved in resettlement of Displaced Persons. Today, I wrote up a memory. I don't remember the name of the other woman, nor all the details, so just made her a composite of several that I remember.

 

 

 

The Changing Room

 

It was a cold, dreary day when we picked up Mrs. Nowak. She was dressed in the only dress I had seen her wearing, a threadbare, pale green and tan plaid shirtwaist dress with long sleeves which hung loosely on her frame. I hadn’t seen her in any other dress since she arrived in Colorado during the summer. My mother greeted her in Polish. She greeted me in broken English. She wanted up to make us breakfast, but my mother insisted we should get going since we had a drive ahead of us. “We’ll eat when we get there.”

She relented and took out her coat. It, too, was threadbare, once red, now faded unevenly, with a black collar. It, like her dress, was probably worn when she got it second hand.

Her daughter was off at school and her husband at work or maybe sleeping since he worked two jobs. She usually worked nearly every day as well. But today was her day off. My mother wanted to take Mrs. Nowak to buy her some clothes, she knew Mrs. Nowak was proud and wouldn’t easily accept charity.

As we drove, my mother and Mrs. Nowak chatted. I wished I could understand, but could only catch a word here and there since I hardly knew any Polish. I mostly just watched the snow. Sometimes a big, fluffy flake would stick to the window in a way that I could see its’ structure, before merging with the others. I loved the trip to the big department stores in Denver. They had so much more than the stores in Boulder, which was still a small town then. Fancy clothes and toys, and this time of year, fantastical Christmas displays, often with moving parts, not just mannequins dressed in the clothes of the season. I was hoping for a new party dress in velvet, maybe dark blue this year. Even then I loved dark colors and jewel tones.

Finally we got to the department store parking lot and picked a spot as close as possible due to the weather. I wanted to go in the front door to see the displays, rather than the side door by the parking. The women relented. The display seemed so magical, with giant nutcracker’s opening and closing their mouths, and mannequins of children sitting under a giant Christmas tree opening packages, some as big as the children.

But we had not come to see the displays today. Instead we headed inside to the restaurant. Mrs. Nowak ate slowly, taking time with each bite. “I can’t eat fast anymore. I have trouble swallowing, still. It’s from the lye.”

“Take your time.” My mother slowed down her eating and looked at me, expecting me to do the same. “We came for the day.”

After we ate, my mother paid for the food and then we headed for the women’s department. Mrs. Nowak looked admiringly at the dresses, fingering them and walking past. My mother noticed a few that she looked at the longest and picked them out. Mrs. Nowak turned to her and said that she couldn’t afford any of them, but my mother persisted, “What harm can it be to try them on?”

“I guess it couldn’t do any harm.” Mrs. Nowak finally agreed. We went to the changing room, choosing the largest since there were three of us. There, Mrs. Nowak took off her coat, hanging it carefully on a hook. She then took off her dress carefully, leaving only her slip. Then I noticed it. She tried to hide it from me, but could not. There was a number tattooed on her left arm.