The frenetic mind: No’s Knife

It’s not often that one goes fresh and fragile into a  situation or encounter to be greeted with a bewildering recognition amidst the distracting newness of the thing. This was my experience of Lisa Dwan’s performance of ‘No’s Knife’ at the Old Vic Theatre.

‘No’s Knife’ is a selection of Samuel Beckett’s ‘Texts for Nothing’ (1950-52), 13 short prose pieces written shortly after his novel ‘Malone Dies’. I was familiar with this longer length text, characterising Beckett’s acknowledgement of, and working through, the inevitability of death. From the outset, ‘Malone Dies’ sets itself up to be a certainty , (‘the’ / ‘a’ death), but through the course of the text, readers are invited to assess the information they are given to work out why Malone is so assured in his convictions. The only certainties become the questions themselves.


The same is asked of us in ‘Texts for Nothing’. The title invites interrogation, with the ambigious preposition ‘for’ offering possible interpretations of purpose, value or motivation – are these pieces gratis, or are they purposeless; indeed, who might ‘Nothing’ be if not understood as ‘no-thing’? Quite simply, Beckett manages to disrupt certainty, and give possible importance to the seemingly inconsequential or themes that self-parade as such.

Beckett, and performances of his texts, are often lambasted for being inaccessible to all but the intellectually elite, or pretentious, depending on who’s making the accusations, but my readings and experiences of Beckett have never aligned with either standpoint. I’d never seen any Beckett performed live before, but I found reading his textual work forms strangely thrilling in the jumble of words and mentally worded sounds.

‘No’s Knife’ affected me in a way I hadn’t expected. I’d preliminarily prepared myself to be inspired by Dwan’s reportedly extraordinary performing tour-de-force, projecting accent, emotion and movement into what was effectively a 70-minute monologue, but otherwise to be left empty – ‘sans plus’.


All this happened – and more. It was impossible to experience Beckett or this performance passively. Humans automatically tune into words and make associations or connections, trying to draw threads and to make sense of nonsense. So the piece became both exhausting and rousing, taking on a life of its own to leave me somehow altered, but not necessarily changed. It has been claimed that Beckett’s texts leave one with nothing, but for me it felt like everything and nothing, not quite an emptiness but an unexpected introspection on what it is ‘to be’.

Perhaps this was, in part, because of the very evident contextual relevance of some of the allusions and concerns of the pieces. As Dwan commented during an interview with her co-director, “Beckett wrote these at a time when Europe was trying to understand itself after the war with resonances with the way we, and Europe are – or is currently – understanding itself”.


It may also have had something to do with the following. I have periods where I momentarily lose sense or experience of self; not in a rational questioning of life purpose but as a sometimes alarming, other times otherworldly, disconnect from a sense of being. It happens at the strangest moments, most recently while I was at the hairdresser. A rare event, and one I don’t find particularly enjoyable, I realised I had lapsed into this form of depersonalisation, looking back at a face that wasn’t even remarkable as a stranger’s let alone definable as my own. I’ve never been able to articulate it, but it doesn’t feel surreal, rather alien. For those few seconds until I consciously trigger a transition to ‘sense’, it is as though my existence is in a  vacuum.

It so happened that I had been experiencing a few weeks of this, after not having done so for several years, with episodes becoming increasingly frequent and extended at the time of this performance. There was resonance in the frenetic, often obscure thinking, the disconnect  between self and substance, between thinking and visceral – not that these are dichotomies, but questions raised, albeit actively, and consciously, in a way that demands your consideration as viewer and being.

And it would seem that I am not alone. Dwan comments of her first interaction with the texts: “what I saw was a transcript of how my mind works […]. They’re a real exploration into the self: into who we are – into identity”. In ‘No’s Knife’, Beckett puts the mind on stage, a stage which featured three sets or planes:  one as though looking down into a jagged, swollen, wound in the ground with Dwan strung across it in various Messiah-like contortions; one on the flat studded with rubble and pooling water and a final spotlight on, alternatingly, Dwan’s face and chest or full body sitting in a swinging chair.


The wounds of the stage landscape extend into the fleshy and mental disruptions of the audience, inviting us to examine them in the space of the performance within the prodding fingers of our own mental dialogue. In the first and final texts, Dwan was somehow constrained, either by the crevace of the swing, concentrating all activity into her core while the ambiguity over who, where and ‘if’ she was alive embodied Beckett’s notion that death is a state of being immobile.

The performance we went to was captioned. Aside from offering a ‘meta’ level, the visualised text was a surprisingly powerful addition, albeit one made for other purposes. While the reading or spectating process is not passive – it feels as though something is being done to you – the process of creating narrative is about anticipating the directions the plot might go from the information you are given. There is delight in this enterprise, and one that Beckett repeatedly turns to, only for him to take us in a certain direction that will be completely overturned later on.


We are in the habit of trying to answer these gaps because as social animals we step into the spaces occupied by other human beings to see how we would experience them ourselves. Gutteral, frenetic, comic, self-conscious, desperate, terrible, religious, safe, unstable, isolating, alienating, togetherness, illusion: all were a part of the performance, both explicit and implicit. I have no doubt that the piece will last with me, not only for the resonances I can pin-point, but also for the multiplicity in its brevity – its state of being whole but with missing parts; parts which will not let you rest.


Photo credits: Manuel Harlan


Let’s All be Free

Regular readers of these pages will know that while global health is prioritised as a general theme, the way it is explored ranges from artistic manifestations to coverage of specific clinical conditions and their context-dependent impact. As the ‘Writing Health‘ section demonstrates, I try to unpack what might be understood by health, globally, recognising its many facets, including mental and physical.

Of course, such understandings are limited by the extent to which anyone can really empathise with the reality of another’s daily life however proximal they might be geographically, but I am regularly presented with windows of opportunity that offer, at the very least, a viewing platform into these spaces. One recent example was an invitation to join the East London based ‘Let’s All be Free Film Festival‘ which explores and celebrates what ‘being free’ means to people all over the world, through artistic expression across 5 days, 37 films, 5 venues.

The medium of film is offered up as an opportunity for artists and viewers to enter a forum to  discuss what being  free means to them, and how peace, prosperity and understanding can be promoted through dialogue and discussion. I joined the festival at the Rich Mix cinema in Shoreditch for a weekend screening of their official selection of shorts aiming to help others see the challenges of life, including the struggles people go through in their daily lives.14694646_10154620701709730_1276603551_n

The line-up included short (maximum half an hour) fiction, documentary and expression films from directors in Palestine to the USA (for instance, ‘Ironhead‘, a documentary directed by Thomas C. Johnson & Neal Abbott) back to the UK. This jostling of origins, subject matter and types was surprisingly productive, inviting audience engagement across self-consciously brief time frames, inspiring emotion to jolt us from horror to sorrow to triggered laughter. Ten-minutes of ‘Till Death Do Us Part‘, a documentary directed by Penelope Antorkas, introduced us to the idea of freedom in abandonment from reality with an escape into a young man, Grant’s, obsession with horror films which he watches with compulsion and ritual but in a manner that brings him an overwhelming sense of fulfilment and pleasure. This freedom is, in his words, about being ‘terrified but safe’ in being able to inhabit the storylines and rote-learned scripts of Friday the 13th films.

Inherently meta, this sense of personal liberty echoed across ‘In A Flash‘, a non-verbal expression piece directed by Sophie Austin in which we follow a girl shopping in a Moroccan souk with her mother. Tired of waiting, we track the girl’s sighting of a cat and her pursuit of it until the scent goes cold and the piece ends abruptly. Like Alice down the rabbit hole, and Grant of ‘Till Death do us Part’, she discovers a strange and curious world that is somehow liberating, just as our own viewing of the screenings allow us to experience these expressions, albeit second-hand.

Meanwhile, ‘Piece Of Cake‘, directed by Ella Lentini, and ‘Wally’ (25 mins), an Andy Galloway documentary, explored freedom and wellbeing in a more recognisable interpretation marking the coming out of, in the first instance, a young woman to her parents about her same sex relationship, and in ‘Wally’ of a father, Christian and teacher in Jefferson City, Missouri, of being gay to his entire community. ‘Piece of Cake’ explored the run-up to this act of liberation from fears of parental rejection, disillusion or ‘pretension’, punning on the title, with the line ‘BTW, I’m gay’ iced onto a cake baked for her parents on their anniversary visit to her apartment life in New York.

‘Wally’ pieced together interviews with the protagonist’s three daughters, politicising the focus by commenting on the contemporary community and theological implications of verbalising freedom through an open expression of sexuality, and the tension between liberty and legality, social isolation and personal incarceration. The piece pitches from Wally now and then, covering ‘sickness’ and depression that he describes as being on ‘the inside’ and the transition to the heartsickness he experienced following his disclosure, including the supposed separation from his daughters.


Perhaps most recognisably, the longest length short in this screening, ‘The Black Friday‘ directed by Jozef Nateel, is a documentary covering the day of that name in the summer of 2014. During that period, Israel had launched a large-scale military offensive against the Gaza Strip that lasted for 51 days, with one day cited by Amnesty International and other Human Rights organisations as Black Friday exposing evidence of Israeli war-crimes committed in Rafah during this period with the deaths of over 140  Palestinians in the space of 24 hours.

The short struck a balance between interviews with locals who survived this offensive and superimposed text detailing statistics and events of the day. Above all, it literally fleshed out what it might mean to lose 140 people from your immediate community, and the awareness that history would, inevitably repeat itself. The loss of freedom is as much the substance of this film as verbal  impressions of what it might mean to live freely. The piece features conversations to camera with Hidaya Shamoon, a journalist and filmmaker based in Rafah. In a particularly moving response, she recalls how a woman questioned her motives in filming the attack on Black Friday, to which Shamoonn responded ‘this will not happen in silence’.

Perhaps this is reflective of the joy and success of this festival: it delivers on its promise to record expressions of freedom, and scales it in terms of experience, singular or plural, global location, all drawing on the inextricable impacts on the health of social interactions with those we share our most intimate lives.

For more information, follow Let’s All be Free on Twitter, or head to their website.


Image Credits: A. Bow-Bertrand


World Mental Health Day: in times of crisis

The importance of raising awareness of mental health, or mental ill health, is ever relevant. Today, Anna Freud National Centre for Children and Families, where I am Press Officer, joined the Heads Together campaign of which we are a partner charity, in marking World Mental Health Day. One of the key aims of the day was to recognise that all of us will experience a traumatic event or transitional period at some point in our lives, and be that involvement in a car accident; exposure to persistent bullying; or a specific mental health crisis, emotional fall-out is often to be expected. With such an expectation comes an opportunity to share how we can be supported through difficult times. Through such distress, psychological support from each other, as well as from professionals, can be invaluable sources of care-giving and therapy.

We supported an event held at the riverside County Hall and the London Eye, attended by Their Royal Highnesses the Duke and Duchess of Cambridge and Prince Harry who met guests with stories of crisis and their supporting cast of friends, family, and education and clinical professionals who have played a role in helping them through these difficult times. Since starting in this role, such involvement with the Heads Together campaign has created a demanding but brilliant opportunity to rapidly implement and develop press skills and promote awareness for psychological wellbeing in a way that carries integrity to the real experiences of those showcased or helped through the work of the Centre.




Of course, working in London, for a national charity, it can be easy to forget that this day is celebrated globally and, further, that such commitment to supporting one another and normalising the conversation on mental health must be a continuous endeavour, rather than the perceived efforts of a single day. With this in mind, and having recently submitted my Masters dissertation looking at the psychosocial impacts on persons affected by leprosy (PAL), it seems as good a time as any to highlight, again, the work of Lepra, the organisation who hosted me so brilliantly in Bangladesh during my primary data collection research in the Sirajganj district. In an article published on their website today, they cited preliminary findings from this research  which set out to: 1) Assess the psychosocial impact of leprosy-related disability by employing mixed methods 2) Determine what is understood by ‘psychological’ and ‘mental health’ among this population and  3) Explore perceptions of leprosy at both personal and policy-levels, and its relation to mental health.

Key messages from this exploration into mental health initially highlight that:

  • Lack of education around leprosy is the primary reason for delayed presentation to appropriate medical services.
  • Within this context, leprosy-related disability is figured solely in physical terms classified under medical frames of reference.
  • ‘Alienation’ conceptualises the life experience of the PAL in this study, influenced by trauma, mental and physical disability, and lack of explanatory theoretical frameworks.
  • Following education, economic seed projects were identified as a sustainable, acceptable intervention to tackle the psychosocial impact of leprosy-related disability on past and future PAL in this region by promoting social integration and financial self-sufficiency.

What these findings show is that education of mental health is critical, acknowledging that it needs regular ‘checks’ and appropriate response to challenges i.e. that parity between physical and psychological health must be prioritised and remain a focus for us all.


Image Credits (all): A.Bow-Bertrand

Header image: Felix E. Guerrero, Flicke


Literature and Mental Health: Heartbreak

Somehow, working fulltime seems to be less conducive to finding inspiration or time for writing on Matters du Monde than an intellectually exhaustive Masters degree. The transition to professional living has brought with it a slow and not altogether comfortable realisation that no longer are the majority of my days filled with the people, activities and academic focuses that I have actively chosen.

Inevitable transitions and adjustments aside, I’ve also found that the routine and demands of my press role sap all creative energy in a way not too dissimilar from that discussed as a part of the Literature and Mental Health virtual learning course which I mentioned I was pursuing in my past blog.

Over the past weeks, the course has explored a series of conditions bracketed by mental health, or mental ill health, through a mix of videos, readings and discussions with actors, clinicians, lecturers and writers. Professor Jonathan Bate is one of the co-conveners, and a particular draw given that he authored many of the texts on Shakespeare I studied as part of my undergraduate degree and of the primary biography of John Clare, whose work I explored in my final year dissertation titled ‘The lost in John Clare’s writings of space and memory’.

The themes explored so far are: ‘Stress’, ‘Bereavement’, ‘Trauma’, ‘Depression and Biopolar’ and ‘Heartbreak’. Across the latter, the course conveners question whether heartbreak is a medical condition. As with all of the themes, the most interesting parts of the course are those where medical professions are invited to contribute their professional and personal insights, in a way that seems to most legitimately bridge discussions of creativity within a biomedical discourse, for instance the psychosomatic experience of heartbreak within and beyond poetry.

The course introduces its themes, which are also broad clinical diagnoses, with a light touch, either unwilling to restrict understanding or to immediately associate with specific literary and biomedical frames of reference. This extends to the set texts, many of which are familiar for being wheeled out at school assemblies or commemorative days, but through the ensuing discussions and participant forums, the texts are afforded reflective considerations that frequently, and brilliantly, manage to extend and challenge the most infamous critiques and interpretations of them.

It doesn’t do the course justice to pull out aphorisms, but there are many to choose from, particularly in the week focusing on heartbreak. Through discussions on poetry writing Ben Okri, we are offered the view that ‘what really good poetry does is coalesce that which you did not know you were feeling into a body of feeling and words’. Perhaps unconsciously, the lexicon of ‘body’ invites interpretations that are both textual and physical, an imperative that echoes across the course and one which is of most interest during discussions around ‘heartbreak’.

GP Andrew Schuman highlighted that recent research suggests that heartbreak can be a physical phenomenon variously called ‘broken heart’ or Takotsubo syndrome, momentarily disrupting normal cardiac rhythms via a surge of adrenaline to the left ventricle of the heart. This chamber pumps oxygenated blood around the body, but while temporarily paralysed it balloons up mimicking a heart attack even though normal cardiac beating normally resumes immediately. Self-titled psychiatrist and poet, Richard Berlin’s Takosubo Cardiomyopathy offers an anatomy in words of this state or transition:

Takotsubo Cardiomyopathy

I’m reviewing a left ventriculography
from a man with chest pain, MI ruled out,
his wife dead for a post-crash hour.
The scan shows his cardiac apex
bulging with each beat, shaped
like a takotsubo, an octopus trap
a Japanese cardiologist recalled
from his childhood fishing village,
the scan just another broken heart’s
beaten down story of futility and resilience.
And I will say, “I am sorry for your loss,”
explain the image, reassure him
his heart muscle will recover in a week,
all the time wishing I could hug him
with eight strong arms instead of two.

Richard Berlin

Such insights are, of course, fascinating and typical of the course, but it is problematic that the nature of being ‘in’ love is not explored, instead dissecting heartbreak or ‘love melancholy’. As one might expect, discussions start with Robert Burton’s seventeenth-century work The Anatomy of Melancholy. The title suggests linking of emotional experience with physiology and, in one sense, the work is wholly true to its title and it remains, to appropriate Kevin Jackson’s assessment, ‘the most exhaustively detailed work in the English language on the subject of that terrible affliction’. However, moving beyond the preface, through the pages, one realises that Burton cannot constrain himself to matter pertaining solely to psychological concerns.

In the same way that the course introduces more than it can cover, the digressive and hyperbolic interests of Burton divert the text from its encyclopaedic titular claims. What Burton does achieve is a re-writing of the characteristic aim of proponents of utopias – an ideal for all – instead, creating an anatomy of feeling and experience that is subjective, personal and to ‘satisfy and please myself, make an Utopia of mine own, a New Atlantis, a poetical commonwealth of mine own, in which I will freely domineer, build cities, make laws, statutes, as I list myself. And why many I not?’ (Holbrook Jackson, p.3).

Burton’s articulation resonates with the uncertainty surrounding the psychological and physiological symptoms of heartbreak, and echoes the course discussion which highlights that heartbreak is different for each individual because the contexts, subjects and spaces that shape wholeness of heart and circumstances that lead to it being metaphorically, or otherwise, ‘broken’, are never equivalent to another’s. The first section, or partition, of the book grapples with possible medical terms or explanations for heartbreak, for instance ‘where the melancholy blood possesseth the whole body with the brain, it is best to begin with blood-letting’ (Holbrook, p.144; from the Second Partition).

However, by the close, Burton’s understanding sits more closely to that of the course discussion – along a spectrum between ventricle and verbal, emotion and electrical impulses, with the envoi: ‘I can say no more, or give better advice to such as are anyway distressed in this kind, than what I have given and said. Only take this for a corollary and conclusion, as thou tenderest thine own welfare in this and all other melancholy, thy good health of body and mind, observe this short precept, give not way to solitariness and idleness. Be not solitary, be not idle’ (Holbrook, p.172).

Perhaps the most engaging question I am pursuing from course discussions is can such a feeling of breakdown (mental, physical, and so forth), determined neither by clear reason nor by accident, constitute a tragic sense of life – one that aligns melancholia more directly to depression than to heartbreak. Surely any question founded on ‘why?’ is key for looking at the idea of melancholy, heartbreak, and creativity and it is from these interrogations that, to my mind, the most intriguing discussions have arisen.


Robert Burton, The Anatomy of Melancholy, ed. Holbrook Jackson (New York: Random, 1977)

Robert Burton, The Anatomy of Melancholy. A Selection, ed. Kevin Jackson (Manchester, 2004)

Image Credit: debaird, Flickr




Literature and Mental Health

I’ve always worked here and there: Saturday pharmacy assistant, casual hours waitressing and six months with a Debenhams concession in the back end of nowhere during my gap year. But not a ‘proper’ job, you know, one that alerts Student Finance England that you now need to pay back a hefty wedge of your monthly earnings that are deposited directly into your bank account, post-tax, pre-tips.

So, on top of a fractured clavicle and trying to finish my Masters dissertation writing up the research I carried out in Bangladesh earlier this year, starting work hasn’t been entirely straightforward. Aside from scrambling for press skills in a new context and familiarising myself with the positioning of the organisation I work for, the loss of a daily reading list (be that for a degree course or a personal long-list) has been quite a shock.

Of course, work hasn’t forbidden personal reading, but seems instead to have subsumed all energy and appetite for it. Slowly, I’ve been easing myself back in with some favourite fiction pieces, but it still feels a bit too soon to get my teeth back into the global health journals and the progressive currency of development-focused material that used to shape the thinking behind this blog.

Looking sideways has also helped. A friend who generously reads these pages recommended The University of Warwick’s ‘Literature and Mental Health’ e-learning programme which started earlier this week. I’ve signed up to virtual courses before, but never fully committed, instead cherry-picking choice reads and passively spying on user forums (not sure how this reflects on me, if at all!). This time, I’m going to do it properly. Engage with the material in its diversity and without a motive to ‘get’ anything from it, other than just to start enjoying hearing the voices of people working and writing in this area again.

I’m going to devote the next few posts to how I’ve found the course: looking at content that has appealed or warrants sharing with a wider audience, and to field your views also. If you want to get involved, sign-up to the free course here. I’d love to hear how you find it.


Travel Photographer of the Year

I’ve been twice before. Once to stand on the line representing the Prime Meridian for a school trip with the Brownie group (all the fun), and again last year to see a late night show at the Royal Maritime Museum. To the Royal Borough of Greenwich, that is. This long Bank Holiday weekend seemed the perfect chance to pose as tourists, sleeping in a local AirBnB spot, vintage shopping in the twilight market and heading to the University which is playing host to the Travel Photographer of the Year exhibition (TPOTY).



It’s the first year that I’ve made it to the show, and it didn’t disappoint with prize titles for both young and adult entries, amateurs and semi-professionals with submissions under portfolio categories titles including: ‘Faces, People, Encounters’; ‘Nature & Environment’; and ‘Monochromal’. TPOTY describes itself as a competition run by photographers, for photographers, with submissions from every continent (over 114 countries are represented), often seeking to highlight points and peoples under cultural or environmental threat.

Upon entry, there is a map that invites visitors to pin where they’d most like to visit in the world, whetting the appetite for an artistic gallop from tanneries in the suburbs of Dhaka to flyover rainbows in Tokyo:

14159868_10154470927289730_2046964138_n The Young Travel Photographer of the Year was the entrant who the judges felt submitted the best entry on the theme ‘Travels Through my lens’. 18-year old Chas Guttman from the USA claimed this title, already a two-time winner of this category, minor Instagram celebrity and recognised travel photographer. His series of images are taken in the frost-laden foothills of the remote nation of Lesotho, where the Basotho people wear traditional tribal blankets for village ceremonies and familial milestones, where shepherds converge on the jagged basalt cliffs of Maletsunyane Falls as the sun begins to rise, and where Basuto ponies are  pictured as crucial to the survival of local Sotho tribes. 14159684_10154470926979730_1689795357_n


Meanwhile, Marsel van Oosten won the overall title for best submissions across the three portfolio categories. Van Oosten is a professional nature photographer from the Netherlands. His images are best known for his graphic approach to composition, the direct result of his previous career as an art director in advertising. In his work he tries to simplify, to get rid of the extraneous. For him, simplicity is the ultimate sophistication.

His images are featured in galleries and museums, and he is a regular contributor for National Geographic Magazine and together with his wife Danielle he runs Squiver, a company that organizes specialized wildlife and landscape photography tours and workshops for small groups of all experience levels to spectacular locations worldwide. His winning series features Danielle canoeing through the eerie cypress swamps of the Atchafalaya Basin on a trip they took through North America, with a self-referential quality often featuring her with poised camera.


The exhibition leads you around the continents, guided by sign-posts that also detail distances to key landmarks around the globe. 14191300_10154470927009730_2097421218_o


The monochromal portfolio category was my personal favourite, with the winning submission from Xia Xuejun beautifully rising to the challenge of creating good composition through light, tone, and shadow without the natural impact of colour. 14138386_10154470926474730_719941436_n


Running until 4 September, this is just one more reason to make a trip down to Greenwich, covering inspiring ground that might just prompt enough to submit for this year’s TPOTY competition. Who knows where it might take you.14138450_10154470927784730_2076612661_n



Image Credit (all): A.Bow-Bertrand


Kala Azar: The Overlooked Killer

The title of this article was awarded an Honourable Mention via Global Health NOW’s ‘Untold Stories in Global Health’ competition. It is also available on their blog, here.

It is unsurprising that neglected tropical diseases get the fewest column inches and remain unknown to vast swathes of the general population. But if you were asked what the largest parasitic killer was, after malaria, would you correctly answer Kala-Azar?

Also going by the names of Leishmaniasis and black fever, this isn’t a disease of the European or Northern Hemisphere masses, despite long causing significant fatality figures and appearing on many NGOs agendas—including Médecins Sans Frontières (MSF), which reports treating more than 100,000 people with the disease since 1988.

Endemic in almost 50 countries and with an estimated 200 million at risk, there are an estimated 201,500 – 378,500 cases a year, according to Lepra (an active NGO working in this field). The unseen Leishmania parasite is transmitted by the bite of the equally insidious yet unprepossessing female phlebotomine sandflies. Tropical areas, especially during the autumn harvesting season, prove particularly hospitable to this vector.

Kala-Azar progresses from skin ulcers at the site of infection to the more aggressive form of visceral Leishmaniasis, effectively destroying the immune system. Left untreated, it almost always causes death through complications of any combination of anaemia, weight loss and vital organ failure, notably swelling of the liver and spleen.

It is also associated with poverty: Lepra identifies it as “the poor man’s disease.” For example, sandflies frequently occupy cracks of houses made from mud commonly inhabited by the poor. The disabling aspect of the disease prevents sufferers from being economically self-sufficient while the burden of treatment costs can push their families further towards extreme poverty.

Unfortunately, being identified with and treated for Kala-Azar is fraught with its own dangers. The most effective diagnostic tools are invasive, requiring extraction of either bone marrow or splenic aspirate to visualize amastigotes (an intracellular form without visible external cilia or flagella typifying the leishmanial stage). Invariably, this diagnostic gold standard is unavailable in endemic areas, but serological testing is a common and generally reliable alternative, according to the WHO.

What is life actually like for someone with Kala-Azar? Lepra’s work in Bihar, India offers a telling insight. Consider 8-year old Ruby Kamari, who was originally misdiagnosed with malaria. Only after a series of referrals and 2 rounds of treatment—which proved financially devastating for her family—is she able to eat a little more than half a chapati (flatbread) a day, sleep in more regular cycles and see the melon-sized ballooning of her abdomen lessen.

Another case echoes this debilitating lack of knowledge across the general population: Devi, the father of a 7-year old son who is 2 months into treatment for Kala-Azar remarked, “We thought it was just a simple fever. We live in a hut, we don’t have the knowledge. If a mobile testing facility and treatment facility came to us, it would make life easier.”

Speaking at the London-based Medsin (UCL) conference in 2015, MSF clinician Ana Garcia Mingo shared her experiences working within conflict areas to curb the spread of Kala Azar. She underscored that after any crisis, preventative care is the first thing that stops, but this is also a truism of this disease across the regions it targets.

While there are no prophylactic drugs nor vaccine for the disease, preventative recommendations as per other insect-borne diseases extend to limiting time spent outdoors, particularly from dusk until dawn when sandflies are most active, and application of insect repellent. Indoors, at-risk populations are advised to apply pyrethroid-containing insecticide to furnishings and to make use of bednets.

Although entirely treatable, inexpensive yet effective chemotherapy is lacking in many endemic areas, not least Sudan, according to a 2008 study published in Transactions of the Royal Society of Tropical Medicine & Hygiene. Although the overwhelming portion of those who receive treatment reportedly recover and are highly unlikely to contract the disease again, access to treatment and both donor and health system awareness of the disease is varied but still, devastatingly, the disease occupies a discourse of the ‘neglected.’


Image Credit: Ruby and her family look out from beneath their bednet. Peter Canton via Lepra.


Year in Review

MattersduMonde has been around for a whole year! With at least one post per week, it’s been an adventure into my own global health reading, writing and the wider blogosphere. Although the blog was originally motivated by a solipsistic need to textually spell out, and consider the aspects of global health that I find most troubling or intriguing, over the past year MdM has gathered a loyal but modest following that extends beyond my own project. Nothing is more self-affirming than finding others who also want to engage with the people, places and conditions that comprise ‘global health’. As well as introducing regular roll-over features, namely ‘Photographer’ and ‘Book of the Month’, some of the personal highlights on the blog this year have been contributions to the ‘Writing Health‘ section, which also became the subject of my TEDx talk. So it seemed as good a time as any to dig through the archives and revisit the top five most popular pieces on the blog since it started, as marked by you – in your numbers and words.

  1. ‘Pakistan behind the headlines’

This piece was a variation on the monthly photography feature, and was particularly popular in that the photojournalist in focus, Sa’adia Khan, was running an exhibition of material commissioned by MSF at Asia House in London at the time of publication. In the blog, as in person, Khan talks through a narrative of this commission, which becomes about much more than getting the perfect shot, and touches upon the struggles to fairly expose the unwritten, hidden and untold lives and experiences of the most oppressed persons around the globe.

2. Writing the Self: Creating Health

To omit this feature from a line-up of highlights from the past year would be falsely self-deprecating. It details how the ‘Writing Health’ section of this blog piqued the interest of TEDxUCL organisers who were seeking speakers on the theme of ‘Growth’, including personal growth. The first tentative proposal meeting found me discussing personal experiences I though had been more than fully explored and discussed in other guises and spaces, perhaps as a direct consequence of a blogging process that found me revisiting health experiences close to home. The premise of TED talks is that speakers have ‘ideas worth sharing’. Perhaps, if there is anything that this process highlighted, it is that unexpected opportunities often call on you to move and speak in ways you never knew needed, or warranted, expression.

3. Dear Mr Cameron

This was the first in a series of commissioned features for the ‘Writing Health’ section in which the intuitive and brilliant Charlotte Chorley uses spoken word to consider the black hole and contradictions of existent policy around and relays received experience of female genital mutilation across the UK. With her own interests including health, development and policy, Chorley’s creative writing is worth exploring. Clichéd, perhaps, but she is one to watch – and it looks like you all agree.

4. Character is what you are in the dark

I developed MdM during my lunch breaks of a summer internship with Roll Back Malaria at the World Health Organization headquarters in Geneva. At the time, I’d recently graduated from Cambridge, had no job definitively lined after the internship which found me communicating around Neglected Tropical Diseases (NTD), a long-held area of interest. I’d also been Press Officer for Polygeia, a student-run global health policy think-tank, so when, mid-way through my internship I decided to start writing about developmental topics of interest, and with no finite plans, I looked into a friend’s recommendation that I pursue a Masters in Global Health and Development. I’m fortunate that I was able to apply and consider my place, starting at UCL the same week I flew back from Switzerland. The finite deciding factor in continuing in education at the time was the prospect of conducting primary data collection for my Masters dissertation. Unsurprisingly, perhaps, this found me researching leprosy, and the mental health of persons with this NTD alongside Lepra, an organisation with whom I had previously volunteered on a policy commission. This blog offers a snapshot of my first days in Bangladesh, where I spent a month collecting data earlier this year.

5. MdM Talks: Daniel Flecknoe on Darfur

For someone who has always experienced an unhealthy level of imposter syndrome, it is surprising that curating a blog has positioned me to narrate the stories of others. Conferences and press events have become a rich source of connections and potential interviewees, with the blog network lively in it’s own right, evidenced in invitations to guest blog for Global Health NOW  (article available here) and to speak at the November conference of Medicine Unboxed. In this interview, Dan shares his own experiences of making connections across languages, and marrying seeming impasses in the conflict zone of Darfur. His professional capacity as a lecturer in public health lends a fascinating research steer to his reflections.

Want more of the same? Areas you would like covered? People interviewed? With feedback here’s hoping the next year on MdM doesn’t just become a personal indulgence and can contribute to the wider global health conversation.


Image Credit: A. Bow-Bertrand

Portrait of young boy from village of Dardiste.

Photojournalist of the month: Tomislav Georgiev

Currently based in Skopje, Georgiev is a photographer who covers the least popular – and populist – subjects and contexts. It is perhaps for this reason that he is so little-known having ducked beneath even the radar of increasingly celebrated photojournalists and war correspondents. He is, however, a member of the Balkan Photographers Collective and numbers commissions from UNICEF MK, the branch based in Macedonia, as well as nationals including Le Monde and The Sunday Times. 

His most powerful work focuses on Kosovo A Power Station, a lignite power station with five units at Obilić. It is the second largest power station in Kosovo and is described as the worst single-point source of pollution in Europe and it is expected to be closed by 2017. Indeed, the A block alone emits around 2.5 tonnes of dust per hour, which exceeds EU regulation standards by some 74 times. The following are drawn from Georgiev’s series called Toxic Legacy and with their associated captions, expose a terrible insight into the lives of the people living within its shadow.

Approximately 5,000 people die each year from cancer in Kosovo. The proportion of those from family units in the Obilić area is far higher than elsewhere and surpasses worst expectations for an otherwise non-urban area. The following billboard is from the local Pristina hospital reading ‘For Good Health’:

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The power plant behind a man with his cow in the village of Dardishte. The local terrain is heavily polluted making vegetable production and grazing low yield and problematic.

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Children play near the power plant:

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Following the closure of Cesmin Lug camp near the Trepca mine in North Mitrovica, Kosovo. The camp was built close to the Trepca lead mine and smelting works. The factory was closed by order of UN administration in 2000 but the slag heaps were never cleared. As a result, the residual lead blackens the teeth of local children, affects their memory and leads to stunted growth. Their activity patterns jump from bursts of nervous hyperactivity to comatose states. Doris Nitzan of WHO said, at the time, “This is the worst ever lead poisoning that we know of in Europe”. The inhabitants from Cesmin Lug moved to the Osterode camp.

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The home of Rodna Zifkovksa with her grandchildren in Osterode camp in North Mitrovica. To limit risk of poisoning, the existent topsoil was replaced with concrete, which was later classified by WHO as “safer” than before. 600 people now live here.

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Hyra Shanini’s house is only 50 metres from the 40 year old power plant. Her only son, Kahmiron, died in December 2010 when he was thirteen years old following  brain tumour, considered directly related to environmental factors. He was initially operated on in Tirina, but Shanini was not able to afford his second operation. Here she is holding her late son’s shoes.

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While Georgiev continues to quietly document the lives of his fellow nationals, awareness of the lasting health impacts and consequences of living within the shadow of polluting giants must be raised and addressed, for the safeguarding of future generations in Kosovo.

Image credits (all): T. Georgiev.


Book of the Month: Self Portraits

Lauded by Susan Sontag as ‘a valiant writers whose work honors literature’, Frederic Tuten is a recently revisited favourite of mine in the form of his ‘Self-Portraits: Fictions’, which was given to me earlier this month. He is best known for ‘Tintin in the New World’ which is characteristic of an oeuvre studded with Borgesian, Conradian and Proustian influences and edged with mystical realism. Published in 2010, ‘Self-Portraits’ brings these same influences together in a series of interrelated stories that offer as much enjoyment as narratorial ingenuity. Cross references and allusions are frequent but lightly spun across trajectories that wind out of control and back again.

Not dissimilar to the premise of this website’s ‘Writing Health‘ section, Tuten’s self-portraits contour lives and experiences through words in an attempt to hold them up to a readerly, or spectator’s gaze. Although not directly claiming to pertain to health, global citizens and readers will relish the thread through tales in which  a young boy barters with pirates for his grandmother’s soul; Death appears as a genial waiter in a bar across from the Metropolitan museum; a lonely man lectures circus bears on the history of art; miniature glaciers tumble from a refrigerator in an East Village apartment, heralding a voyage to Antarctica on a frozen schooner anchored in Tompkins Square Park with two lovers reappearing time and again in new guises, through new voices and in new places.

Reading as escapism is true of all of Tuten, but especially of this work. Writing at the close of the Prologue, he muses ‘Stories. Like air, like food, like hope. I read them, I told them, and later, I wrote them, stories about men and women seeking the faraway in revolutions, in art, and in the dreamy search for love’. I can offer no better invitation into another world.


Image Credit: Tournesols, A. Bow-Bertrand