Monday, July 11, 2005


On reading the ISI Newsletter I discover that I am a cultural creative as opposed to a heartlander. Very interesting.

I believe in the utility of self-congratulation: positive self-regard is healthy. I suspect, though, that a non-contextual self-definition is rather too abstract.

Friday, July 08, 2005

London Blasts

I would like to extend to all Londoners my sympathies and, to those specifically who have lost loved ones, my heartfelt condolences.

To all those involved in the emergency responses I must admit awe: very well done!

Wednesday, July 06, 2005

SEXUAL HISTORIES: An approach to the Pious Muslim Woman

Taqwa, God-consciousness, is central to a pious Muslim and the need for congruence in the presence of non-Muslims acts as enforcer with regard to the required observances. Sexual history taking is always difficult and more so in pious Muslim women for this reason. Expectations tend to create barriers; this holds true for all patients.

I will discuss imaan, yaqeen and ikraam; the position of sexual intercourse in the Muslim household, and the barriers and facilitators to access for sexual problems in Muslim women. Finally, I will make some recommendations in order to improve the services offered to Muslim women.

Imaan. Simply, this is faith – belief in the seen and the unseen, belief in (God) Allah, the eternal soul and the afterlife, belief in Redemption and Divine Justice.

Yaqeen. This is the belief that Allah directly does everything and that only He can do: nothing happens except that He wills it.

Ikraam. This is consideration of another’s welfare, (physical, social and emotional) before attending to one’s own.

Sexual intercourse in the Muslim household
Marital relations are included in the contract of marriage. A wife has a right to refuse the sexual advances of her husband only if there is compelling reason to do so e.g. she is ill or menstruating or sexual intercourse is contra-indicated by a medical problem. A husband has a similar duty to fulfil the sexual needs of his wife and may only refuse if there is compelling reason to do so.

Sexual intercourse is prohibited when a woman is menstruating and when either husband or wife is fasting (compulsory fast). Conjugal relations are permitted at all other times and are recommended at least once weekly, usually on the night of the Sabbath.

A husband has no right to the performance of oral or anal penetration nor does he have the right to intercourse in circumstances where his wife’s modesty will be compromised. A husband does have the right to sexual relief/fulfilment even if his wife is unable to engage in penetrative sex: such relief can be provided by manual stimulation by his wife, but he may not do it for himself. If his wife cannot even do the latter, a man may take another wife in addition to or instead of his wife.

Sexual intercourse is very important in marriage and its lack, consistently over time, is sufficient cause to end a marriage. There is, therefore, strong reason for partners in a marriage to present if the husband is sexually dissatisfied; a woman is less likely to present for such dissatisfaction especially as it may imply criticism of her husband’s ability.

There are several barriers and facilitators to women accessing sexual dysfunction services. The greatest barrier to such access is health professionals’ lack of training and experience dealing with sexual problems. The next is women’s internalised societal expectations regarding their own sexual fulfilment: this is less of a problem than in the Christian tradition, which equates sex with Original Sin. In Islam, women are recognised as sexual with the same drives and desires that men have. The next barrier is ikraam, which requires that a woman hide the faults of her husband. A further barrier is that women will only initiate discussions of sexual problems with female clinicians.

The facilitators to women accessing sexual dysfunction services are: the importance of a husband’s sexual satisfaction in marriage and the recognition that women are sexual and also have needs and desires to be fulfilled.

Ultimately, it is up to the woman in a marriage to decide whether or not a sexual problem experienced by the couple is sufficient cause to present to a healthcare provider dealing with sexual dysfunction. It is very unlikely that a woman will present for enhancement of her sexual experiences if there is no dysfunction.

What can we as healthcare providers do to improve the sexual health services offered to Muslim women? First, we should keep sexual dysfunction in mind whenever a woman presents with a chronic medical or severe surgical condition that can be expected to adversely affect her sexual functioning. In these circumstances, women must be asked, explicitly, “Are there any problems in your marital relations?” or “Are there any problems in your relations with your husband?” It is advisable not to use the words “sex”, “intercourse” or “sexual intercourse” because these terms would tend to make the women uncomfortable. The clinician involved should always ask this screening question, whether or not the clinician is female.

Second, women should preferably be seen by women and if they cannot be seen by a female clinician they should have the option of being referred to one or of having their appointments rescheduled so that they can be attended to by women. If it is not possible to have the patient attended by a female clinician, it will have to be expected that patients will withhold important information and that management will be compromised.

Finally, as with all patients, an assurance of confidentiality and a comfortable, professional environment is a sine qua non.

[Published in South African Sexual Health Association Newsletter 2001.]

Wednesday, June 15, 2005


a boy came down echo farm going home.
home is johannesburg kl.
kl may not originate proper questioning rapport.
rapport should truly underlie virtuous...
when xenophobes yak zzzzzzzzzzzz....

It may truly be nonsensical; it may not: GIGO. It does faithfully follow ABC to XYZ. Perhaps you can improve it for me?

Monday, June 13, 2005


charly was born plain dumb
charly was born dumb
charly was born
charly was

Sunday, June 12, 2005

Journals, Anne Frank, ...

I began my first journal at 12; that was more than two decades ago. I am reminded because today was Anne Frank’s birthday.

I would have liked to have read through those early journals of mine but whenever I thought that I had passed through the particular developmental stage I had been in I destroyed the journal. I believed that I continually reinvented myself and in a sense that was true. I did not want representations of the pupa to survive.

I do not remember the exact reasons: I am no longer the child I was. And that is the reason I would now like to read those journals. I am not the child I was.

The essential problem with hindsight is that we cannot recreate past psychological states. The promise of technologies like this blog is that they create durable records of current states as text or pictures or audio or video. Our lives will be recorded; perhaps they may even be examined.

Friday, June 10, 2005

Again. Again. Again.

I used to be perfect. Now I just am.
I used to be a poem. Now I am a single note.
I used to be a whole meaning. Now I am.
Now I just am.

Life is like this.
Life is like this.

You know it:
life is just like yours:
trivial, unremarkable, ordinary
Life is like this.


Friday, June 03, 2005

Acceptance extended

joy and rapture both,
as pain and anguish, are
points along the wave

the recurring waves
reach no asymptote, therefore
carpei diem - now

true zanshin attends
agony and ecstasy
to the beatific

Thursday, June 02, 2005

Beauty Realised

Beauty realized:
Snowflake, spider's web, starlight,
A lover's tears: care.

Wednesday, June 01, 2005

Life balance analysis

Life balance analysis: physical, spiritual, familial, social, intellectual, work and cultural activities.

Work on positive emotions.
Pleasure, ecstasy, happiness, bliss, thrill, enjoyment, elation, joyfulness, joy, joy, joy …
Serene, composed, relaxed, Peaceful, tranquil, calm
Affection, adoration, friendship, devotion, passion, tenderness, love

To know excitement and calm, passion, tenderness, ecstasy and simple, profound joy.

Tuesday, May 31, 2005

Comity and fairness

Comity and fairness go well beyond law and justice. Justice is the impartial application of the law and the law is a matter of legislation. Law gave us Treblinka and apartheid.

It is accepted that good people can do bad things: there is a difference between action and disposition. And circumstances can be extenuating. Life can be harsh; it is certainly and indubitably unjust. However, that does not necessitate that it be unfair. A will to fairness is hard-wired into our brains: we know it when we see it.

Children of 3 and 4 can tell you credibly that something is unfair.

Comity and fairness constitute the essence of the social contract. Cooperation is a superior survival strategy and gifting is both selfish and altruistic: there is a social ecology.

Monday, May 30, 2005

Time a Haiku

Acorn yields old oak

And egg births the greying sage.

… Time’s sands measure… Life.

Sunday, May 29, 2005

Trust and the sexes

"In a game of mutual trust, women's brains show a big dopamine or reward
response when they are trusted by others; there is no such response in
men's brains."
Dr. P. Read Montague, a neuroscientist at Baylor University in Houston

Saturday, May 28, 2005

Random Musings 2

We choose always; sometimes by default.

People are not to be understood. We do not make sense.

So what does it all mean? We insist on meaning! We suffer its lack acutely. All is Maya. Truly. is all a question of meaning. Purpose, Frankl observed, is to be discovered.

We don’t have difficulty deciding what we want: our ideals are easy enough, however mistaken they may be; it is the compromises reality insists on that are problematic.

Fortune cookie wisdom. “Action is distilled intent.”

Tomorrow is another day.

I’m quite clever at times; quite profound at others. Silly often. Human always. I continue to learn things that in retrospect I believe I should have learnt long ago. However, common sense is as always exceedingly uncommon.

Friday, May 27, 2005

This is alone life

This is alone life:
Purity, chastity and
Sublime decadence.

This is alone life:
Desire and Decision:

This is alone life
To burn like a bonfire,

This is alone life
To know and be known through true
Tender Ecstasy.

This is alone life:
Ecstasy and Agony
Merrily coupled.

More Haiku

Sunrise marks Day’s birth
Launching Life’s latest voyage
To Day’s end: Sunset.

Wabi and Sabi:
Perfectly deficient,
Flawed beautifully.

Wabi and Sabi:
Mortal forms: men and women
Flawed beautifully.

Wabi and Sabi:
Immortals in mortal form:
Men, women transformed…

This is alone life:
To know passion, pain, love, loss
And say Yes! Always.

Random Musings

I am supposed to reflect.
Wisdom. And all that.

Everything is negotiable.
Price is not a true reflection of value.
Life is short – “too short to be small”.

Thursday, May 26, 2005


joy and rapture both,
as pain and anguish, are
points along the wave

Wednesday, May 25, 2005

How good is your thermostat?

Thermostats adjust temperatures taking into account the environmental temperatures due to the weather. Good thermostats, using fuzzy logic, learn to bank oscillations so that they over- and undershoot less widely and less often. If the target temperature is 21 deg Celsius, a very good thermostat might operate in the range 20-21,5 deg Celsius. As they get better they might narrow the range to 20,8-21,2 deg Celsius.

This is another instance of OODA: observe-orientate-decide-act.

“How good is your thermostat?” is shorthand for how flexible are you and are you reactive or proactive to feedback inputs? Remember, physiological systems use multiple feedback loops – some long, some short: they are nature’s thermostats, both reactive and proactive in managing homeostasis.

So, how good is your thermostat?

Haiku 3 as one

Greatest happiness:
inimitably cherished:
Adam before God.

mother's joy peripartum:
her own miracle.

Life's true miracle:
wafting fragrance of incense:
Your life fully lived.

Three pictures you should see:

Adam before God, Mary with Jesus, the fading smoke of an incense stick (without the incense)….

Tuesday, May 17, 2005

On Crime, Safety and Fairness

I was approached recently by a home security company about having my street patrolled for 12 hours daily at “a reasonable cost for peace of mind”.

Peace of mind cannot be bought. And guards, dogs and cameras cannot provide security. For some, I expect that they do provide “peace of mind” – for a while.

Guards, dogs and cameras do provide a cue: only valuable things need protecting and valuable things are worth stealing, particularly because there are willing buyers. And so the circle goes.

I ask myself continually how these cycles can be disrupted, countered, destroyed and always I come to this same conclusion: I need only do the right thing. Only me, not everyone else and not all the time, but only as often as I can manage it. It is a simple thing. And it is so incredibly difficult – not in the conception of it or even in the doing of it from time to time but in the additional requirement of constancy.

To do the right thing.

I am not selfless, I am not extraordinary and I am no hero. Life is a struggle and I have lost my illusions of control. I have not lost my anger.

I have an unremarkable anger: ordinary, because I have learned that all South Africans have it: it is formless and without a target, without a clear cause excepting a marrow-in-the-bone sense of injustice. Some blame apartheid and Bantu education, but it is an anger that cuts across race and social strata. I have no doubt that you have it.

I have it despite my education, my material comfort and my loving family. I have been a victim of crime several times and of ingratitude that hurt and angered as much and yet that is still not sufficient reason because I had it before and after.

The poor have it too. The hungry, ignorant poor have it in abundance shielded by a moral righteousness. My anger has no shield, my relative privilege leaving me without the moral high ground and yet it persists. I cannot blame the poor for their poverty as I cannot blame the sick for their debility. I have not caused the problems, but I find myself labouring under a presumed obligation to fix what I did not break.

I did not suffer? I did not cause the suffering!

A friend speaking plainly said that the world did not owe me a living. He was right.

Life is not only about obligation. We are built to be fair and nothing cuts as acutely as the accusation of unfairness, but fairness is not enough, our humanity, our sympathy is bound up in generosity.

We need to gift. Not charity, which creates a barrier between the receiver and the giver. We need to extend our circles of friends through gifting – little things will do as well as great because it is the exchanges that matter: they show that we care and they free us of the burden of fixing that which we didn’t break.

Only in our caring – our visible caring – can there be peace of mind because only in our caring can we demonstrate equity. The poor are oppressed by their poverty, but they blame the “rich” because there are few connections between them and so, little evidence of caring.

To be a good husband or wife is the same as being a good parent or neighbour. And it is the same as being a good friend. It is caring, visibly. It is many little things, often. We are so often disastrously misunderstood by those closest and dearest to us and yet our relationships endure because we care. How much greater the misunderstandings across culture and race? How intractable in the perceived lack of caring?

Necessity is the mother of invention and there is no greater necessity than self-preservation. I know without doubt that if my talents and opportunities had not been enough for survival, I would have been a criminal – there, but for the grace of God, go I.

Without equity, without caring, there can be no security, no peace of mind.

[Letter to the Editor, Daily Newspaper in South Africa, Oct 2003]

Monday, May 16, 2005

Language is an engine

Language is an engine: it does useful work; it makes and breaks things. It includes body language.

All language is embedded in context and this is why reputational effects are important.

Actively exclude “but” from your language: it is toxic; use “and”. And state the positives, not the negatives. Semantically a double negative is positive. Instrumentally it is not.

The Prophet Muhammad (PBUH)is reputed not to have said “No” – this is entirely possible based on reputational effects: not agreeing, others would have learnt was his way of saying “No” – like the Queen’s, “That’s very interesting.”

Saturday, May 14, 2005

Baby Rape

All rape is horrendous. All violations of person are horrendous.

There is no acceptable rape and no gradations of unacceptability.

One writer observes that we are a Godless nation, another that the government has it’s priorities skewed and all find themselves incapable of expressing the full extent of their horror especially as parents of babies and toddlers. And yet none states what (s)he will do personally to end this sort of event: society should do something or the government or the police.

It is this sort of thinking that preserved apartheid, that made Hitler Fuhrer and that makes our problems apparently intractable. It is thinking that someone else must solve the problem.

Schelling points out that the good gets done if individuals act alone to do the right thing: no central command, no over-arching authority or organisation is needed to accomplish the apparently Herculean; only ordinary people acting on conscience.

We condemn. We complain. We pray.

Do we act? Not to punish but to prevent? Have readers and listeners asked themselves what they will do to prevent this happening to someone else?

One must know despair and desperation first-hand. Those who suffer do not do so vicariously….

I am indeed my brother’s keeper. And in this we are all guilty, all diminished, our horror notwithstanding.

[This letter appeared in The Star (South African Daily, Johannesburg) in October 2003.]

[Context: there had been a report of a rape of a 1 year old baby with significant physical injuries. Rape is common in South Africa and survivors of rape are getting younger because of the mistaken belief that HIV/AIDS can be cured by having sex with a virgin. Younger age is a proxy for virginity.]

Letter to the British Medical Journal: A Palliative

Socioeconomic imbalances have a habit of exacerbating themselves: we call them virtuous and vicious cycles. And it is near impossible to change the one into the other.

The world is increasingly one integrated system and costs and benefits are not directly linked. Those who benefit are not those who pay.

Conscience may persuade some – some of the time – to pay for the value they receive. These discussions serve as part-payment, a salve to conscience, but no pragmatist expects or believes that the brain drain will be reversed.

The convenient solution is to introduce friction to the free movement of health professionals: the health professionals pay, the benefiting countries say, “See we have made it difficult for them.” And the losing countries are left with nothing.

The entire argument seems misplaced. Seen as a unit, the whole world suffers from a dearth of health professionals.

Poor countries – Developing countries – need more health, not more healthcare or more health professionals. Below a recognised threshold, health equates with income, both direct and indirect (the entire focus of public health initiatives: potable water, sewerage systems, electrification, telephones, roads, mass immunisation, etc.) and yet still the health of nations focuses on the movement of health professionals.

A cardiothoracic surgeon or interventional radiologist can do nothing for the health of a nation sitting on a dune in the Karoo or looking off a cliff in the Himalayas. Implants of NGF producing cells for Alzheimer’s are irrelevant to a population dying of cholera for lack something simple and inexpensive: potable water.

The health of a nation has very little to do with the movement or the numbers or the training or the remuneration of health professionals: America and Cuba are the proof of that.

I am in favour of dialogue and I will award myself Brownie points for this piece; I know that it will make no difference to the health any nation, but I will feel better and that will certainly be good for me.

Competing interests: health professional

[This letter appears in the online edition of the BMJ April 2005 and will appear in the print edition in June 2005.]

Thursday, May 12, 2005

Two recommendations I’d like to offer

Two recommendations I’d like to offer: Human Knowledge 2000 by Brian Holtz and the Wikipedia. They are both memes and may they propagate far and wide.

I’ve suddenly realised that Michael Porter’s teaching on strategy is essentially an argument favouring commitment: to commit to one thing is to say “No” to everything else. This is like evolution being about relationship.

The brain operates on massive parallel processing; so does society. We just need freer, more open real-time communication.

This story does not have a beginning, a middle and an end….

Thursday, May 05, 2005

Time and Ends

"If you can fill the unforgiving minute..."

As we grow older our subjective time seems to speed up; we attend less. A week seems to pass in a blink unrecollected.

I was surprised to note that I had not posted anything to this blog for more than a fortnight: lack of attention. I had made no commitment to post to any schedule, but I did have an unspoken hope of doing so rather frequently, constraints permitting.

Stream of consciousness does very well, but I remain in an adolescent fog of possibilities, unable to choose.

I tell myself, Begin with the end in mind.

There are so many desirable ends. And ability is not a constraint.


So, an end: Self-definition. Towards being a humane humanist who believes in God....

Thursday, April 14, 2005

Dialogue as Self-definition

I have long held that self is emergent and that dialogue is self-defining.

We can think about things for which we have words because they allow us to talk / communicate about them. Symbolic systems are very useful.

We are not born liking and disliking things; we learn to do so.

Thursday, April 07, 2005


Human maturity is an interesting concept albeit misleading. The belief that there is some endpoint to development is encouraging – there is a goal to reach. The truth is that no such endpoint exists. Maturity is essentially about appropriateness, about “fit” and that is contextual.

Maturity is about managing our self-perceived inadequacies in the face of our roles and responsibilities. Just as there is no courage in the absence of fear, so there is no need for maturity in the absence of tensions due to expectations.

Maturity is essentially an evaluation of human ecology. We forget that we judge others more harshly than ourselves.


I had a look at the Foreword to “Big Book” put out by Alcoholics Anonymous in 1939: very intriguing. It addresses governance and credibility succinctly. The world has changed considerably since then, but human problems have not.

Trust is the basis of all commerce, all intercourse. In unstructured situations amongst strangers there is almost always little or no trust. This is our challenge for the future: the creation and maintenance of trust across lines of similarity.

Trust is not an issue limited to Palestinian-Israeli relations or the war in Iraq or the interactions of multinationals in developing countries. Intent lies at the heart of trust. And because we cannot know others and are disproportionately averse to loss or pain of any sort we find it very difficult to trust. Relationship requires time and familiarity.

A prayer: Open my heart, Lord, that I may accept….

Wednesday, April 06, 2005

What to do with a googol?

I have asked myself this question several times and it is essentially this: if there were no resource constraints, what would I do with my life?

I do not yet have an answer.

What would you do?

World peace is not dependent on resource constraints but on people and their incompatible desires. World poverty is a consequence of allocation decisions not resource constraints: friction and entropy can be minimised....

I have learnt that solutions cannot be imposed and brute force produces ephemeral results.

Journal of Mundane Behaviour

There is a Journal of Mundane Behaviour. The ordinary celebrated. The ordinary examined.

“Every pleasure or pain has a sort of rivet with which it fastens the soul to the body and pins it down and makes it corporeal, accepting as true whatever the body certifies.” Socrates

Free association; tangents; community. Have we met and touched?


Geneering makes possible the use of humans as bio-factories for hormones, blood products including immunoglobulins, seminal cells and milk. The possibilities are mind-boggling!

This is also what makes them terrifying.

We already live in a world without control and Pandora’s box is infamous. Look on the bright side: you live in interesting times….

Welcome to the Future of Medicine.

Tuesday, March 29, 2005


Another earthquake hits Indonesia.

Disasters are truly not rare. Sadly.

The Illusion of Control

I forget continually. And I am reminded continually. We labour under the illusion of control.

Everything is a risk, a gamble. Anything can happen with varying degrees of probability. Fact is that bad things happen quite frequently: tsunamis, wars, plagues, famine ....

Bad things happen so frequently that we are in danger of suffering disaster fatigue.

The illusion of control enables us to act in the hope that we can make a difference! We can and we do - mostly through the law of unintended consequences.

Control is an illusion with great utility: behave as if you are in control - and keep in mind that you are not.

Life is lived best in the maintained tension of opposites.

Thursday, March 24, 2005

Moderation in all things

All things recur. Repetition is important.

I revisit first principles because they are first and they do work: good habits, small wins and balance. These apply irrespective of domain. Savings, diet and weight loss, study and self-development, parenting and anything else you can conceive of that requires a consistent effort over time.

So many people are overweight and unfit it's almost depressing. Even more people are unprepared for retirement....

We have narrow time horizons and many cognitive blind spots.

Repetition is important.

Friday, March 18, 2005

Privacy vs utility

I am willing to trade privacy for utility. The essentials of our lives don't differ; only the mix.

There is some level at which every other is unknowable despite all the explicit statements that we can make.

Nor is character static. And reputation, as you know, is extremely fragile.

Everyone lauds communication but communication without purpose is just that - pointless.

I am still asking for dialogue instead of monlogue....