Friday, February 13, 2009

St. Valentine & St. Trifun--a suitable couple



We all know that tomorrow brings hearts, chocolates, red roses & wine, poems, and fancy dinners to light up our late winter sorrows, but here in Macedonia there's another reason to celebrate--St. Trifun.

Another saint who was martyred during Roman times (though there were actually a couple of St. Valentines), St. Trifun's day is a name/feast day for those bearing his name (such as the mayor of Skopje--Trifun Kostovski). But as I've mentioned before, there are hundreds of such saints' days, so that's not what's so interesting about it. The interesting and funny thing is that, in this country of significant wine production, St. Trifun is considered the patron saint of the vineyards, and his day is a celebration and beginning of the new grape-growing season. Perhaps it's just another excuse to drink, and how this association came about I can't seem to figure out (despite inquiring).

Known as a healer in the 3rd century AD, he was from Phrygia in what is today western Turkey. Rumor has it that his healing powers were so great that, as a teenager, he was summoned by the Roman emperor Gordan to heal his ailing daughter. He did so successfully, but not long thereafter he was forced to renounce Christianity under the rule of Emperor Decius. He refused, and was tortured and murdered for it.

How his name day came to be celebrated is not too difficult to gather, given the millenia's old ties of Anatolia with the Balkans (from Alexander the Great to the Ottoman Empire), but what's even more interesting here is the possibility that Trifun's ancestors were from Macedonia and around to begin with. I don't seek to be irredentist by any means here, but only to state that, according to Herodotus, the Phrygians originally lived in the Southern Balkans and migrated to western Turkey as Trojan allies under the protection of Troy. The Phrygian language survived centuries of invasions, lasting till the 6th century when it gave way to Greek.

Regardless of the history, this holiday of St. Trifun is making me wonder whether his name and people haven't been around all along, one ingredient in the melting pot of Macedonia. Given the millenia of wine making here, perhaps during warmer eras (and the region is known to have been previously warmer and more arid, with more of a desert and savvanah climate), February 14 was just the right time to start working the land again.

These days, despite the more Mediterranean climate in the south of the country, it might be a bit early to expect life from the soil when snow is still falling (as it was today), but the ritual and celebrations exist. What are they? Tomorrow morning in churches in the Tikves wine region believers will gather to see the priest prune the first vine. Thereafter it is divvied up and passed along to spread good fortune in life and vineyards. Some priests and parishioners continue on to the vineyards themselves, pouring wine onto the soil and drinking it as well. Workers will begin clearing the vines from last year--cutting and burning them--but not before the jubiliation and possible inebriation has its way.

For on St. Trifun's day, people offer grape brandy and wine freely and they celebrate life and the new season to come with a feast. Therefore, what better holiday to pair with St. Valentine's than a day of imbibing wine and brandy? I can't think of one.

Friday, February 6, 2009

On mumps and medicine

Perhaps it's due to my family's involvement with public health medicine or maybe it's just a wise thing to stay tuned into, but regardless, public health is a great interest of mine. Unfortunately, it's probably because I'm sick far more often here in Macedonia than in the US, and thus I've always pondered and fretted about my and other people's health here. When I was a Peace Corps volunteer I used to regularly clean a greenish-white sludge out of my PC distributed water distillation system. While I drank the water that came from it, I always worried what I was drinking when I was at school, in a cafe, or someone's home. Things are no different here in Skopje, and as a result I spend $20/month buying spring water from the mountains in 6 liter jugs that I pick up at the grocery near my school. I consider lugging those things up four flights of stairs well worth it.

The unfortunate thing is that a lack of general concern and action over public infrastructure and health characterize this country. We sporadically hear about the increasing number of miscarriages, cancer, infections in hospitals, and less severe situations, but little is done to investigate them.

Fortunately, there are people interested in changing this, and I've begun working with them at an organization here in Skopje. Unfortunately, two incidents in just as many weeks are at the fore of my mind in reminding me of the acute situation in Macedonia that could result in disease transmission at best, and a major epidemic at worst.

The two events I'm referring to are my own illness last week, how and where I was treated, and the outbreak of mumps in high schools throughout the country this week.

Personally, I fell ill last week with a vicious stomach virus. I lost an incredible amount of bodily fluids and thus went to the state hospital here for medical attention. Not only was I mis-diagnosed (the doctor wanted me to get an x-ray for possible bronchitis) but I was attemptedly ripped-off (but fled before paying!) for being American, and frightened that I might have picked up something else in the waiting room of the clinic. For it was filled to capacity with ill people who were waiting and waiting for attention. Perhaps they all got what they needed, using their government issued pink slips to cover their medical needs (it is still a nationalized medical system here), but I'd gather that some did not. That I do not know.

What I do know is that my brother-in-law, who is an oral surgeon resident at the hospital, informed me that the disposal of medical instruments--primarily needles and syringes--is totally out of line with health regulations. Used and infected bandages, needles and the like are mixed together, and while some are kept isolated and destroyed in a secure location, others are merely put in the dumpsters for stray dogs and cats to go through. Stray animal management (and lack of it) is a whole other story in itself, but unfortunately these creatures can act as agents of transmission--vectors--to their and our species' populations. I also know that in my wife's hometown all medical supplies are thrown in with the town garbage, driven 5km outside of town (but upwind from it) and burned. Yes, rubber gloves, syringes, plastic bottles and bags, and all other refuse are pushed daily into a giant furnace, their smoke then floating over the town and into the valley below.

But back to my illness, I suppose I shouldn't bite the hand that fed (or in this case, healed) me, as I was fortunate to be able to head to that small town's hospital for immediate treatment last week--getting an IV put in to rehydrate myself. I recovered after many days of weakness, taking an antibiotic (though having had a virus, I don't know if it was so wise for me to have been given such a medication...), and on a lighter note--the doctor insisting that I just drink herb tea. Lots of it, hot or cold! Oh yes, and I had to eat dry crackers dipped in said tea as well. An odd and rather unpleasant combination...

Unfortunately (I'm using this word a lot, I know), what's occurred this week in Macedonia, a European country, is more indicative of corruption and a serious lack of effective healthcare policy at the national level: there has been a mump's outbreak. Right, you're thinking "Mumps? Don't we get vaccinated for that when we're tiny tots? What the heck is it anyway??" Well, yes, we do get vaccinated and they should be here as well. Unfortunately, from 1990-94 (and that's for the current outbreak's age range) they didn't and thus this week in high schools across the country hundreds of cases of the highly contagious, greatly unpleasant illness have arisen. Teens necks have swollen and all they can do is suffer from the pain and hope it recedes soon, as there is no real cure for mumps.

Fortunately, mumps doesn't kill, but it can cause permanent damage (particularly to males' reproductive systems). What's worse is that the government is now on a mission to vaccinate all students again, so that the evening news is filled with images of public health workers injecting students with vaccines. Anyone who knows a thing about biology, vaccines, and the human body, however, might know that this could be a potentially catastrophic remedy. Injecting a vaccine--which is a deactivated version of an infectious virus--into someone's body where a live virus may be harbored but still dormant, can potentially activate the latter and lead to infection. Mumps epidemic is one thing, but what if it was a virulent flu, measles, or other virus? Would the government act the same way?

One thing I do know that further illustrates the government's image vs. reality is that they have touted their implementing the administration of the HPV vaccine for teenage girls. Realistically though, they only purchased a few thousand of these vaccines for a female teenage population of tens of thousands, and thus the vaccine is not as available as it might seem. The organization with whom I work has raised this issue, and my brother-in-law has confirmed that only the connected can get the HPV vaccine.

It is just a shame that the country's and region's public health is being compromised by greedy and selfish individuals who seek to profit at the expense of other people's health. Maybe this week's outbreak and other such issues will be brought forth in next month's presidential and municipal elections, and act as a catalyst for change, but I'm not optimistic.