Saturday, August 23, 2008

The Health Situation in Libya: Part I cancer

"Every single time they called or I called [Libya] they told me of someone who just died or who is dying. The cause of death is either a car accident or cancer." Laments Sereeb.

For a country of less than 6 million people this statement should raise a thousand red flags!

Sereeb was not the first one to notice this anomaly related to chronic diseases, I pointed out in my previous post that "I have lost six friends to cancer, while another five are in various stages of survival/remission. I have also lost one to a heart attack, and two to car accidents and I have one friend recovering from a stroke." This means at least 11 of my friends have cancer; I have not brought up the neighbours, work colleagues, family members, acquaintances and their families, neighbours etc…thinking exponentially and factoring in the funerals I have attended I would say it is a national disaster.

Before you proceed to my report below please ensure you read and understand this disclaimer: the following is not a research done by scientific methods. I have no hard numbers or statistics to give but only my own personal observations- so please do not use it as a weapon against me or Libyans.

OK – with this out of the way we can move on…

My first observation that something was amiss was when the number of miscarriages in Libya spiraled alarmingly in the mid 80s. From that time up to now I can confidently say that the majority of Libyan married women have had at least one miscarriage during their first year of marriage and before the birth of their first child. This is NOT NORMAL. Notice I said majority – not all! For those who did not have a miscarriage then we need to dig a bit deeper and of course there are always exceptions to the rule. I noticed this first with my aunts who began founding families in the mid 80s. I also noticed that this phenomenon began in the mid 80s onward roughly when the following international issues were unfolding.

o Eldorado Canyon
o The Chernobyl disaster (the fires did last for 10 days)
o The Aozou strip border conflict
o Desert Storm

For the sake of objectivity I would like to add the following factors:
o Social upheaval
o Environmental Pollution

I've read many articles, papers and books and I understand that my story could be criticised as unsubstantiated, but I'm simply searching for a cause not conspiracy theories or a scapegoat.

Two essential things I've noted during the last decades:

(1) Fertility has decreased in Libya, families now average 3-5 kids, whereas before it used to be 6-10. Increasingly IVF pregnancies are sought in Jordan (for the sake of discretion as this is a sensitive topic) Meanwhile Libyan women are showing a range of gynae/obstetric complaints. The UNICEF report gives us the following figures for total fertility rate in Libya: 2006 = 2.8, in 1990 = 4.8 and in 1970= 7.6. Not sure what that means. [ref]

It could be socially related such as marrying later in life of course but not if it is chronic-diseases-related.

(2) Cancer in all forms is widespread but particularly, breast, ovarian and uterine cancer in women, prostate cancer for men and leukemia and cancer of the stomach in both genders. I don't think it is due to improved screening process because we don't have that kind of attitude and culture established yet. Ex: Libyan women in their 30s do not automatically have mammograms or even breast self examination at home.

Basically when Libyans go to the doctor it means it is serious.

Surveillance of non-communicable diseases in Libya and particularly cancer may not yet have been underway. But in 2003 there was apparently a first attempt at collecting such data in Benghazi. The population in eastern Libya is 1.6 million; cancer cases registered in 2003 were 997.[ref]

The annual report from the Secretariat of Health and Environment for 2007 is finally out and it apparently contains a survey of cancer cases registered from both Western and Eastern regions of Libya, but the electronic full copy has still not been loaded to the official website.

A- Social/cultural causes:

National authorities have reported that 13% of the mortality in Libya is attributed to cancer as a result of social and lifestyle changes ( ex : change in smoking pattern and prevalence).

B. Environmental issues possibly due to modernization, sanctions and military ambitions

(1) Water pollution:
"The combined impact of sewage, oil byproducts, and industrial waste threatens the nation's coast and the Mediterranean Sea generally. Libya has 0.8 cu km of renewable water resources with 87% used in farming activity and 4% for industrial purposes. Only about 68% of the people living in rural areas have pure drinking water. The nation's cities produce about0.6 million tons of solid waste per year. [ref]

Potential hazards are detailed here as well.[ref]

(2) Carbon Emission:
Libya has the highest CO2 emissions per capita in Africa on a par with Japan and UK. [ref]

The ILSA act of 1996 most probably had some kind of detrimental impact on these results by preventing investment in the oil sector that could have helped purchase equipment and material to curb this environmental disaster.

(3) The quest for chemical, biological and nuclear arsenals:
Various attempts were exerted since the 80s with Rabta, Sebha and Tarhuna plants being among the most famous along with the Tajoura nuclear research reactor as Dr Joshua Sinai kindly mentions in this now old (1997) but relevant analysis.

Anyway as we know these efforts all culminated in Libya's now famous dismantling of its WMD programme in 2004. However, we can only guess whether these activities have released toxins into the environment. There are no studies to my knowledge.

(4) Agriculture and Aquaculture:
Libya is on the Mediterranean and Tuna is a staple Libyan diet a study in 1997 reveals that the metal levels found in it are not considered toxic. [ref]
I don't understand those results but maybe blogger Maya M can. I'm sure someone did a more current survey.

As for crops, I fear there is indiscriminate and uncontrolled use of pesticides, but that is only my hunch. I've also noted too many plastic houses in farms. As for cattle and poultry I think that businesses are abusing the public trust with the imported cattle feed but then greed and corruption is universal.

For some at a glance statistics which I don't understand, look here,

C. The Aozou Strip:

This "long stretch of desolate land located in the middle of the Sahara Desert [has been a] zone of contention among the colonial powers of Africa, and […] between the now independent and sovereign countries of Chad and Libya". Libya captured it in 1973. "It remained in Libyan hands until a Chadian offensive in the late 1980s. In 1990, the two countries finally agreed to take their dispute to the International Court of Justice, which ruled in early 1994 that the Aozou Strip belonged to Chad." [ref]

We won't dwell on the casualties or the historical ownership for this land which was stupidly given up/left in limbo in the 50s (another story), but the salient question is
"Why would two countries engage in hostilities over a stretch of desert? According to rumors, the Aozou Strip contains rich deposits of uranium." [ref]

This is related to pursuit of military advantage mentioned in paragraph B(3) earlier. On the other hand although the common understanding is that uranium has not been mined yet, but in the proverbial fog of war we have no idea what happened, but what we can be certain of is that uranium is radioactive and toxic.

D. Chernobyl:

Photo source [ref].

Information states that " there is no evidence nor any likelihood of an increase attributable to Chernobyl in birth defects, adverse pregnancy outcomes, decreased fertility or any other radiation-induced disease in the general population either in the contaminated areas or further afield." But it also states that "the lighter material [released] was carried by wind over the Ukraine, Belarus, Russia and to some extent over Scandinavia and Europe." [ref]

Yet crops, flora, fauna, milk, water bodies and fish have been contaminated in Europe [ref]

A recent study in 2007 maintains that kids were affected in Sweden because their mental development was impaired in utero. [ref]

Apparently the radiation cloud from the Chernobyl accident was "eventually detected all over the world. Events, such as volcano eruptions and nuclear bomb testings, result in major effluent emission that also can be detected with very sensitive equipment.[…] on the other hand the occurrence of chronic affects may never be validated because such relatively small increments are statistically indistinguishable in the face of the great variability of spontaneous cancer rates." [ref]

D. Desert Storm (the Gulf War):

That's very close in the Near East and what is interesting to know is this bit: " The third and largest phase of the air campaign ostensibly targeted military targets throughout Iraq and Kuwait: Scud missile launchers, weapons of mass destruction sites, weapons research facilities and naval forces.[...]Allied bombing raids were successful in destroying Iraqi civilian infrastructure. 11 of Iraq's 20 major power stations and 119 substations were totally destroyed, while a further six major power stations were damaged.[28][29] At the end of the war, electricity production was at four percent of its pre-war levels. Bombs destroyed the utility of all major dams, most major pumping stations and many sewage treatment plants, turning Iraq from one of the most advanced Arab countries into one of the most backward. Telecommunications equipment, port facilities, oil refineries and distribution, railroads and bridges were also destroyed." [ref]

While destruction of enemy infrastructure maybe a standard procedure in war I am left to wonder what sort of toxic material was released from all this and particularly how much. From Iraq to the region needs only a short leap of imagination.

That was before even hearing about the depleted uranium. " They were told depleted uranium was not hazardous. Now 23 years after a US arms plant closed, workers and residents have cancer " [ref].

In a 2003 article in CS Monitor, I read with shock and awe that " depleted-uranium bullets are made of low-level radioactive nuclear-waste material, left over from the making of nuclear fuel and weapons. It is 1.7 times as dense as lead, and burns its way easily through armor. But it is controversial because it leaves a trail of contamination that has half-life of 4.5 billion years - the age of our solar system."

No comment!

E. Eldorado Canyon
This was an aerial bombing of Libyan cities in 1986 (you can read my rant here).

I'm wondering what was the ammunition; what 'shit' did the bombs that fell on us from the sky contain? this site though interesting and lengthy provided no concrete information [ref]

From the Chernobyl cloud it is clear that meteorological patterns were a contributing factor in the spread of toxic pollutants to Europe, it is therefore easy to believe some material may have been carried from Europe to North Africa or to the Middle East. From space photographs the zone affected is wider than thought. I remember vividly that day in April 1986 as it came not too long after the US bombing over Libya; and the sky on that day was grey and murky even though we had not heard about Chernobyl immediately.

Blogger Shlemazl who grew up in the USSR and is coincidently a nuclear physicist (I think) could be able to help me understand.

Right on the thread of weather and climate, I would like to add that Libya has famous sandstorms whereby "dust from the Sahara Desert can be transported over thousands of kilometres by convection currents, which also cause other meteorological conditions, such as thunderstorms. Because the Sahara, where sandstorms are very common, is a major source of mineral dust, large concentrations of the dust can be found in the tropical Atlantic and the Caribbean." [ref]

Hence looking at photos I have no problem imagining what can be carried in these particles whether from the desert or back from Europe. If you look at my photos here from 2006 you will have an idea [ref]

Since military hostilities and industrial accidents (as we know) do have an effect on the environment and this can be compounded by the weather peculiarities and since we are an oil producing country, Highlander became curious about pollution indices in Libya. I could not find much except for a study on the Gulf of Sirte area for levels of radiation. I'm sure it is fine but again I'm not qualified enough to decipher it. Volunteers are welcome.

In conclusion cancer alone in Libya is of epic proportion. I would venture to say it is the number 3 killer and I'm not sure such a large number of cases is normal. I tried to think of all the possible causes but as a layperson and someone not in the field of medicine or research I understand my limitations and accept that I could be wrong but at least maybe it can inspire some thoughts. What I am sure about though is that too many Libyans are dying of cancer.

I believe that Libya's biggest concerns are chronic diseases, with cardiovascular, cancer and diabetes topping the list, while the no. 2 killer are road traffic accidents (RTAs) which are not a 'disease' but which if not fatal can result in debilitating injuries. I will devote a special post to RTAs, meanwhile the next post will discuss Libya's health system and will not be limited to cancer.

Let me know what you think…

Sunday, August 17, 2008

Keep smiling a never ending hope…

Five years ago today I was chatting with my great friend Mahmoud. At that time he was at the intensive care unit at one of the famous hospitals in Amman (Jordan). Mahmoud was having his chemotherapy treatment for leukemia and because he was left with extremely low immunity following this treatment he was vulnerable to the most harmless microbes by our standard. Mahmoud had to spend weeks in a special room where people could only visit him wearing what I would call aeorospace gear or CDC suits. But Mahmoud had a laptop and internet connection and I could keep him company and even see him online. He had his mobile as well but we only used it briefly because it would tire him.

On that day we were talking about his progress and how much he felt better and was only waiting for his blood count to improve to be able to return to Tripoli. He was alone in Amman as usual. He has been going for his treatment there for two years and had finally beaten the monster. I was at the office and I was chuckling at the jokes he was cracking and marveling at his spirit. After all he kept the secret of his illness almost two years and only told me recently before this trip.

I knew Hamoudi from college, we were in the same year and the same study groups throughout the entire academic process because we were classified alphabetically and also by our ranking in class. We shared the same bench, courses, helped each other to study and do homework, and after we graduated we compared notes and met up regularly to catch up on each other. He would call me every time he was traveling abroad, and he would come and visit me upon his return always bringing chocolates and gifts. The only long periods when he did not call were the times he was having treatment before I knew about his battle with cancer. Never once did I hear him complain, never once utter a sigh. In his presence I had immense joy and calmness, and his eyes radiated warmth and sincerity. So we were chatting and as usual I was sending a lot of emoticons with smileys when he suddenly sent me a heart shape. Then he typed that the nurse is asking him to rest and that he will talk to me later. I said good bye and logged off.

About ten or fifteen minutes later Hamoudi sent me a text message "keep smiling ..always!"
I thought of ringing him up but the moment passed as I had a meeting so I rang him after the meeting, but his phone was not being picked up so I assumed it was on silent mode and rang him the next day.. but the next day his phone was closed so I assumed he was doing his usual silent treatment when he wanted to rest and not be disturbed. And I told myself he'll contact me when he comes back home or when he feels like it as usual.
I was thinking to myself that Mahmoud was a wonderful friend and his gentle behaviour and considerate actions let alone his longstanding friendship were not negligible and if he asked me to marry him as he had been hinting about for the last year and as mum was expecting from the stories I shared with her I would accept because he was someone you could trust to build a home with.

A few days later I was at a meeting outside my office and ran into another classmate Aisha. After the usual greetings she asked me:
- Highlander have you heard about Mahmoud?
- What about him I said? I was chatting with him a few days ago he's getting better and coming home soon.
- Oh I'm sorry H, she said, he had a cold and didn't make it..
I was awestruck ..when when did he die I uttered how can he die we were just talking and laughing a few days ago he even sent me a text message here see the date on my mobile! That's the date he died on Aisha said. Suddenly I felt my chest close and the tears welled up inside my eyes, have they brought him ? yes his brother did and they are burying him today in their village. Can we go and attend the burial are you going? who is going? Well his brother informed us and he said that the girls don't have to come because the village is very far and he knows it is difficult for you to drive alone. Do you have his phone number I said ? I want to talk to Hamoudi's brother and check with him are you sure he is dead maybe you are mistaken? Aisha told me she did not have the phone number but will try and locate it and will let me know.

When I went back to my office I was frantically calling our close classmates to ask them and yes most of the guys heard and were going to the burial. But I still could not believe it. Then an idea struck me, I will call Hamoudi's Libya cell phone and if someone else picks up then he is dead for sure. I rang the phone, after 3 rings a voice answered; it was similar to Hamoudi's but more subdued where Hamoudi's was full of laughter. "Hello I croaked my name is Highlande and I am Mahmoud's friend from university is the news true ? " I had a sinking feeling but I still hoped against any hopes until his brother Mohammed shattered my hopes… " yes miss H. Mahmoud has passed away… thank you for your condolences and please as I told all the other girls we do not expect you to be here please your phone call is enough…" but how I said ? It's God's will he replied he had a cold he went to lie down to rest and died in his sleep he was simply too weak..
I hung up the phone and cried and cried silently in my office. He had died alone just after he sent me the sms…and before logging off I had told him goodbye instead of the usual 'talk to you soon'. As if his soul and mine knew already… was he lonely? Did he hurt? Was he afraid ? what were his last thoughts?

It's been five years but his number is still programmed in my mobile I can’t delete it and his last message is there peering at me from time to time. When I feel the world crushing at my sides and the pain unbearable, I scroll way down to his message and read 'keep smiling …always'…even from beyond the grave his words have brought me hope and courage to continue the journey. Thank you Hamoudi you will never be forgotten.

Since we graduated I have lost six friends to cancer, while another five are in various stages of survival/remission. I have also lost one to a heart attack, and two to car accidents and I have one friend recovering from a stroke. The plight of my friends has brought something important to my attention the health situation in Libya, but that dear readers would be the subject of my upcoming post.

Wednesday, August 06, 2008

Islamophobia ( photo courtesy of this source)

In 1997 Islamophobia was defined as "an outlook or world-view involving an unfounded dread and dislike of Muslims, which results in practices of exclusion and discrimination" [source]. In 2008 I would say the definition can incorporate harsher terms which are no better examplified than by this 'cartoon' forming the cover of the book Islamophobia Making Muslims the Enemy.

Exhibit 1:

"Martyn Gilleard, a Nazi sympathiser in East Yorkshire, was jailed for 16 years. Police found four nail bombs, bullets, swords, axes and knives in his flat. Gilleard had been preparing for a war against Muslims...[..] The Gilleard case went all but unreported. Had a Muslim been found with an arsenal of weapons and planning violent assaults, it would have been a far bigger story.
There is a reason for this blindness in the media. The systematic demonisation of Muslims has become an important part of the central narrative of the British political and media class; it is so entrenched, so much part of normal discussion, that almost nobody notices. Protests go unheard and unnoticed."[source].

I would go so far to say that it is not only entrenched in Britain but in most of the so called West and its western allies , sympathisers and wannabes.

Exhibit 2:

Remember the guy decapitating a fellow passenger on an intercity bus in Canada? A witness described that "the suspect had the victim on the floor of the bus and "was cutting his head off and pretty much gutting him." [source].

What did the authorities have to say ? I've looked at more than 30 news articles about this and all of them where either copy paste of this sentence or a variation thereof :
"Public Safety Minister Stockwell Day called the attack bizarre, but did not discuss details, saying he did not want to jeopardize the investigation." [source 2].

No mention of ethnicity or religion :) is that not strange. Also the disgusting act is labelled as BIZARRE !!! nooo is that the best you can do ? Now sit back and imagine that the murderer was Muslim or Arab or a combination of both :P the language would be more colourful and we would hear no end of it on blogs, news broadcast, international media and even the most obscure media in the West. I can visualise the title. Muslim Terrorist hacks head of innocent bus passenger! and you know what I would be erring on the side of conservatism. In fact I'm am waiting any time to hear that the murderer may have descended x-generation ago from Muslim stock just like Obama ;) ( no I won't get into this cartoon although it is highly relevant).

This is what Islamophobia has come too. !

On one of my trips a few months back (yes I still travel a lot but don't necessarily share with ye folks anymore :P) my eyes hungry for novel things to read were scanning the bookshelves at this store and fell on the cover of a book non other than the one I'm using above to illustrate Islamophobia. That one drawing was the summum in other words the 'sum of all fears'. So I bought the book. Most of what was in it was not news to me but still it was good to see that some people who were not necessarily Arab or Muslims had realised the extent of the problem. I felt no anger and no resentment but only pity tinged with a pinch of disappointment at people who are/have become Islamophobes and are fanning the fires of Islamophobia because they should know better since they have at their fingertips all the options of access to information. Before you come and tell me about the very informative website such as this one and similar hatred oriented propaganda, I will tell you that I do read those too and there are ones of the same calibre where you can switch 'Muslim' and 'Islam' for any other faith, skin colour, football fan movie star:) or anything you wish for on this planet and start bashing them.

"While “Islamophobia: Making Muslims the Enemy” examines images of Muslims in media like TV and the movies, the strength of the book — and its focus — is its collection of cartoons published since 9/11, most of which portray Muslims unfavorably. The cartoons show violent, oversexed males, oppressed females, deceptive foreigners. The cartoonists, the authors argue, frequently conflate terrorist groups or the Taliban with Muslims or Arabs in general. [The authors] attempt to place the cartoons in a historical perspective dating to the Islamic conquests and the crusades. The illustrators, the authors write, “drew on images they associated with Islam, having inherited these conceptions from the Orientalist artistic legacy of the United States, as well as from impressions — perhaps latent — of Islam understood from European history.” [source].

Well as I said I read the book and the most significant paragraph for me was on page 2 of the introduction chapter that as a result of this rising Islamophobia, "Muslims in the West and elsewhere know that now as has been the case since the Era of the European imperialists ruled over most Muslims, what they think about Christians has far fewer consequences than what Westerners think about Muslims". On page 3 of the same book and interesting paragraph also caught my eye :

" If you are skeptical about the notion of Islamophobia, get a piece of paper and brainstorm. Write down, with as little thought and as much honesty as possible, all the words that come to mind when you think of the words "Islam" or "Muslim". What names, places, events, ideas, practices, and objects do you associate with these terms? "

What was the answer of most Americans who took this exercise ? Bin Ladin, 9/11 , Palestinians, jihad, veil, Sharia, Iran, Arabs... why ? because they conclude from the media portrayals that all this negativety must be reflecting the religion and its 'associated cultures'.

I decided to study the answers of my readers to such an exercise -not to root out the Islamophobes from the others ( I already know them anyway) but to compare notes and observe the extent of Islamophobia at play. Two months and 34 comments later and you have all proved my personal opinion.

A- Libyans/Muslims/Arabs :
Peace religion, great culture and civilisation, abused and misunderstood, some attempte dsatire :P

B- Westerners, and other non-Arabs and non Muslims subdivided into several subtypes:
(a) hardcore Islamophobes displaying stereotypical even taunting behaviour; with no intention of making an effort to learn. The ignorance and arrogance demonstrated was appaling.
(b) Plain Islamophobes - whom there is still hope to remedy what I could only call a form of discrimination/racism.
(c) Curious and enlightened individuals, seekers of the hidden truth beyond the obvious, willing to learn and see the other side
(d) People with an obviously multicultural non insular attitude.

I was thinking of answering each and everyone but then I changed my mind. Future posts and world events are bound to turn attitudes around, decrease or increase hatred and dismiss ignorance with knowledge.