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ko-fanatic · 3 years

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Blood, Guts and Chocolate Cake (Part 3)

Rating: Mature

Fandom: Danganronpa

Pairings: IshiMondo

Summary: Breakfast before the show, and Mondo realising he loves Taka's music if it's live. Still, there's something too close to a disturbing premonition burning under Mondo's skin, and the idol's comments, actions and frame just make it worse. Something's going on with him...

TW: Alcohol, and eating disorders (both restrictive behaviours and B/P), mentions of disability, underage sex/sexualisation, drugs

Other parts: Part one | Part two

Kiyotaka did not, in fact, get to finish his allotted miles.

Mondo, in his defense, had attempted to continue, but after another mile his lungs had given up on him. Taka was so concerned, hearing his wheezing breaths, that he’d gotten him to spill about being asthmatic. The idol then promptly freaked out, calling a taxi to take them back to the hotel and insisting that he’ll keep his workouts to a gym setting in future.

He could tell Taka was upset - he might be callous, but he wasn’t stupid. Still, the kid said he was just antsy, nothing to worry about. Excess energy he hadn’t had the chance to burn off.

After a while of sitting on the couch, watching the TV that was way bigger than it had any right to be, he wasn’t actively dying anymore. Therefore, Taka saw it fit to leave him for a bit as he pottered around, doing idol things. He could hear Taka practising one of his songs in the bathroom as he performed his ludicrously long skin care routine.

Honestly, he was more focussed on Taka’s singing than the shitty sitcom on TV. He’d heard the polished, studio versions - who hadn’t? - but this was something else. Fuck autotune, for sure; Taka’s voice was beautiful, crisp as a bell and perfectly trained. But rather than the polished version, Taka added more vocal tricks and a generally interesting style to the song that he’d never heard before.

If there was more of that in his official audios, Mondo would’ve been an avid fan by now.

“And if you got a little more time, baby let me hold your hand in mine,” The idol sang as he strolled into the kitchenette, opening the fridge and retrieving an apple, “Drink you up like the finest wine, lick you off my lips before showtime -”

“Whoa,” He whistled lowly, unable to help himself, “Those lyrics aren’t very ‘sweet boy next door’.”

“Oh,” Taka blinked, seemingly just remembering he wasn’t the only one in the room, “That was actually my original version, before it was reviewed. Too lewd for the image, I guess.”

“Or they didn’t want a bunch of tweens bustin’ their first nut in public,” He chuckled, Taka’s nose scrunching in disgust.

“Ew,” He huffed, retrieving an apple from the fridge and starting to cut it up, “I’d rather not think about that.”

He just smirked, not bothering to turn back to the mindless crap on TV, just watching as Taka prepared his breakfast. He was about as meticulous about cutting up that apple as he was his choreography; while anyone would cut an apple into segments (barring bento making), Taka halved and cored it before cubing the frankly pathetic slivers of fruit he was left with.

The cubes were small, almost diced, and quickly scraped into a bowl like they'd burn Taka if they so much as brushed the pale, thin skin of his hands. Then, a bottle of lemon juice was procured, sprinkled on the un-diced half of the apple before it was wrapped in cellophane and sealed in a Tupperware box. Just watching the methodical, practiced actions had Mondo raising an eyebrow; Taka sealed that half apple away like some corny Hollywood curse. Like it would come back for one final scare if he didn't get rid of it.

He expected another fruit to be taken from the fridge, making up a small fruit salad, or for bread to be put in the toaster. Hell, he'd be cool with the promise of Starbucks or McDonald's on the way to the venue, but no.

Taka sat next to him on the sofa, chopsticks in hand as he daintily picked at the meagre portion he'd given himself. His frown only deepened when he saw just how little it amounted to, barely obstructing the bottom of the bowl from view. It hardly counted as an apple, looking far more like peelings you’d throw in the garbage than an actual meal.

“That it?” He asked, gesturing to the ‘meal’ as Taka placed a particularly small cube into his mouth.

“What do you mean?” The idol asked, raising an eyebrow, “It’s my breakfast.”

“Yeah, no shit Sherlock,” He grumbled, “I mean, ‘wow, kid, you eat less than a fuckin’ bird, go get some more’.”

“Half an apple is perfectly fine,” Taka defended, putting down his chopsticks to properly argue with him. It made a pang go off in Mondo’s chest, especially as his eye was drawn to the small bowl, resting on Taka’s thin thigh.

Most people’s thighs pool when sitting; flesh, whether be muscle or fat, generally molds under pressure. However, there was still that oh-so-lauded gap between the boy’s thighs, hardly more than bone. It made him… uncomfortable. Like seeing a cancer patient on their final days; only Taka wasn’t dying, ashen complexion notwithstanding.

“Yeah, no, it’s not,” He spoke bluntly, no preamble, “You did a three mile run, and you’ll be in rehearsals all day. Half an apple’s not going to keep you going.”

The idol rolled his eyes, muttering something about how his run should have been five miles, and picked up the chopsticks once more. He seemed to just push the fruit around his plate, however, instead of bringing piece after piece to his lips like he had before.

“What -?”

“Lost my appetite,” Taka shrugged, standing on those tiny, boney legs once more, “I’ll have something later.”

Mondo didn’t comment, not wanting to upset Taka more than he, apparently, already had. He simply watched as the peelings got scraped into the bin with the rest of the apple, hardly eaten. Maybe the equivalent of a couple bites.

He didn’t say anything, considering he’d already put the kid off his food. He’d make a note of it, but he mainly put it up to nerves for tonight; big venue, and didn’t they say that stage fright was an important part of this shit?

“Looking forward to the show?” Taka asked as he washed up his bowl, chopsticks and knife.

“Honestly, yeah,” He nodded, kicking his feet up onto the coffee table, lounging around like he owned the place, “I’m not a huge fan of pop, but what you were singing now was cool. Guess I like live music better than studio versions.”

“Honestly, that’s completely valid,” Taka smiled, “I prefer doing my own thing, with no editing to slow me down…”

---

Mondo was having the time of his fucking life! Taka wasn’t kidding about editing slowing him down, the guy was a beast on stage.

The stage lighting pounded down on the idol, refracting off the metallic accents of his costume and catching the beads of sweat at his temple. Two hours of jumping around, dancing, singing, and playing his guitar, and he showed no signs of slowing. The adrenalin was high, and it vibrated through Taka, the crowds, the stadium itself and straight through Mondo himself.

If he was a cheesier person, he’d say it was like he could feel Taka’s own heartbeat through the music, resting in his chest next to his own. But he wasn’t that sappy. Nope. Not at all.

He certainly wasn’t prepared for Taka to remove the prince-like, white jacket to reveal the costume underneath. A crisp button-up was par for the course, but the leather harness buckled around his torso made the simple look jaw dropping. Finale outfit, he’d heard one of the costumers mention, but he hadn’t been paying attention at the time.

The leather looked so perfect wrapped around his thin body, and Mondo was screaming. Internally, thankfully, but this was going to be his end.

The song wasn’t long at all, maybe a couple minutes. Like a vast majority of Taka’s “approved” songs, it was about love; albeit darker. A couple heavily veiled allusions to bondage, both in the fun and not-so-fun senses, a feeling of wanting to pull away but being far too in love to do what was healthy.

The crowd just ate it up, even if it gave Mondo an odd feeling… Foreboding, perhaps? Some sort of anxious buzzing under his skin, like a premonition, but no basis in anything he could actually pinpoint. It wasn’t like he could see Taka’s eyes, or anything like that. Maybe a slight tremor in the voice, but fuck, the kid had literally been singing for hours.

After the final guitar riff, and a couple breaths, Taka grabbed one of his water bottles off the front of the stage, not even hesitating to dump it all over his head. The screaming from the crowd managed to increase tenfold, and he was pretty sure the whole stadium was enjoying the view of that white shirt turning translucent and clinging so enticingly.

“Thank you and goodnight!” He cheered, stage lights going out and allowing Taka to walk off stage with minimal awkwardness.

“That…” Mondo began, Taka holding up a finger as they disconnected his mic, making sure none of the sounds backstage got broadcasted and ruined any spell the audience was under.

“Sorry I had to interrupt you,” Taka apologised, so sweetly sincere, “You were saying?”

“Just… That was incredible…” He breathed, still slack jawed from the rush of the concert, “You… I…”

“Articulate,” Taka smirked, hand on hip as he sauntered off to get changed, before he would exit and be swarmed with both eager fans and paparazzi alike.

Mondo was smiling, heart still hammering, until his attention was brought to what was visible beneath the sodden fabric.

Ribs.

#danganronpa #dr talentswap #idol!ishimaru #bodyguard!mondo #ishimondo #Kiyotaka Ishimaru #mondo oowada #blood guts and chocolate cake series

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weeklyreviewer · 5 years

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Japan’s Would-Be Silicon Valley Wants You

Masashi Tomita, who leads municipal efforts to attract tech startups to Fukuoka, Japan, is laugh-out-loud tipsy. The laughter is a clue, but so is the empty mug of Mega Jim Beam Highball, his third. We leave the bar and roam the streets for shime, or drunk food, hunkering our hankering at a solo yaki-ramen cart in the posh Tenjin district. Clinking glasses of plum liquor, I ask what I think is a cheery question: “Why can’t all of Japan be this fun?” He looks crestfallen, not insulted but embarrassed.

The Japanese call it nazonazo, a mystery upon a mystery, a riddle: Why is Japan — a 130-million-strong G7 nation with the world’s third-largest nominal GDP, bullet trains, robotics, a space program, and tech renown — such a dud in the startup world?

For all its business and engineering prowess, Japan has just one unicorn, or privately-owned, venture-backed tech company worth at least $1 billion, according to CB Insights. For the record, that company is artificial intelligence startup Preferred Networks.

But despite behemoth native power players including Honda, Mitsubishi, Nintendo, SoftBank, Sony, and Toyota, its corporate salaryman circles are full of squares, by design. Nearly every member of the Japanese workforce is a de facto senior vice president of rules and regulations. Japan’s national sport is protocol. In June, the country’s largest initial public offering of the year raised ¥33.8 billion ($315 million) and shares soared 21% on the first day of trading. What was all the fuss? It was Sansan, a tedious business card management app and sales-lead generator.

But what if the lack of Silicon Valley-style disruption is a cultural asset? Consider the Japanese art of kintsugi, in which broken pottery is repaired by filling the hibi, or cracks, with gold. What if “move fast and break things” — the early Facebook motto adopted by brogrammers everywhere — isn’t lost in translation as much as it’s discarded in translation? Why break when you can beautify?

Cue the startup incubator

Cue Fukuoka Growth Next, the country’s largest startup accelerator, which debuted in 2017, refurbished this May, and in August launches a nearly half-billion yen internal venture capital fund, FGN ABBALab, that will double investment in the next year. The fund is bankrolled in part by Mistletoe, owned by Taizo Son, the brother of SoftBank CEO Masayoshi Son.

Backed by 22 companies, including Fujitsu, Ricoh, and Seiko, FGN joins other global tech hubs in the hopes of becoming its nation’s, um, Silicon Hibi. On site, in a converted three-story elementary school built in 1929, there are no foosball tables or vintage arcade games like in Silicon Valley. The whimsy comes from within.

Fukuoka Growth Next startup accelerator in Fukuoka, Japan.

“This city has been accepting different cultures for 2,000 years. And 100 years ago Toyota was a concept of entrepreneurial spirit—it is within us,” says Tomita. “We got organized after the war, but uniform—same, same, same—salarymen. It’s time to take our neckties off.”

Fukuoka, on the west coast of Kyushu, Japan’s southernmost big island — a five-hour bullet train ride from Tokyo — is preternaturally suited to the task. Amid Japan’s infamously aging population, Fukuoka’s 1.6 million residents comprise the nation’s youngest city. That includes 80,000 students across 19 universities (a 120-member student club at Kyushu University runs an office at FGN).

The exquisitely Instagrammable Kawachi Wisteria Garden nearby and Nokonoshima Flower Island, surf town of Itoshima, and wine country across Kyushu, famed for its hot spring spa towns, give Fukuoka a distinctly California vibe — as does its diversity.

Large populations of American, Chinese, Filipino, Indian, Indonesian, Korean, Nepalese, Portuguese, Thai, and Vietnamese immigrants were bolstered by relaxed labor laws in March. The Fukuoka Asian Art Museum, which has collections from 22 countries, bills itself as “the only museum in the world that systematically collects and exhibits Asian modern and contemporary art.”

The port town is the cruise ship capital of Japan, not including the ferries that jet to and from nearby Busan, in South Korea. And Seoul, Shanghai, and Tokyo are just two hours away by plane.

The world is at its fingertips. The city’s unofficial mantra is samiyasui (easy living).

The force behind the tech push

Fukuoka, Japan

Its youngest-ever mayor, Soichiro Takashima, a television news anchor elected in 2010 at 36, returned from a trip to Seattle intent on remaking Fukuoka in its image. In 2014, he convinced the federal government to declare Fukuoka a National Strategic Special Zone. FGN opened three years later, in tandem with a startup visa specifically designed to lure foreign entrepreneurs. The mayor still drops into FGN almost weekly.

Future prospects are buoyed by Fukuoka Smart East, a 124-acre smart city campus in Hakozaki district that will be a playground (and showroom) for Internet-of-things prototypes and hydrogen power, with its own accelerator division within FGN. In June, a smart city incubation program launched. But that kind of thinking has already begun: in January, Line, Japan’s largest social network — with 78 million users — tested a digital wallet in Fukuoka.

Yuichiro Uchida, FGN’s executive director, throws his arms into a human emoticon: ¯(ツ)/¯. “There’s just less pressure here,” he says. “That leaves more room for creativity and inspiration.” His bemused grin radiates “duh.” He continues: “Tokyo aims for the U.S. or London for status. But our proximity to Asia — Korea, Taiwan, Hong Kong, Singapore — is our strength. I’d rather be big in Asia than big in New York or San Francisco.”

To keep stress low, FGN offers free consultations to startups on, say, accounting, copyright, or intellectual property (what Tomita calls “startup defense”). Uchida talks about the smart city project as a “grand vision,” a physical, infrastructural white paper.

When we meet, Uchida is dressed down in a t-shirt. A rugby star in school, he’s now 43, but retains a boyish breeziness. In contrast, his entrepreneurial radar is mature and specific: the drone startups of Bordeaux and its Darwin station, the design scene in Copenhagen, tax structures in Singapore, and the European Union’s de facto IT bureau in Tallinn, Estonia. I ask him what’s better than creating — what is the entrepreneurial equivalent of omotenashi, Japan’s hyper-hospitality? — and his answer is kyoso: co-creating.

His is a train of thought born of wabisabi, the Japanese notion that imperfection is often better than perfection. As Tomita puts it: “I value diversity. You can’t embrace diversity and expect perfection.”

At its debut, FGN’s initial goal was for its tenants to raise ¥500 million ($4.6 million) by December 2018, but they instead raised ¥8.2 billion ($75.9 million). Amid the Japanese economy’s Abenomics, the fiscal reforms of Prime Minister Shinzo Abe, FGN offers a radical oasis of wabisabinomics. As opposed to existing for the sake of getting on Google’s radar (and the acquisition bounty that comes with it) FGN’s startups seem genuinely, refreshingly focused on their users in a way that prioritizes purpose and risk over buzz and security, harkening to the era when Silicon Valley was defined more by garage-built moxie than IPO bluster.

Sakiko Taniguchi developed Nyans, a social network for cat lovers, at FGN. “There’s no word for salarywoman but there doesn’t need to be when you’re family. Here I have drinks with the mayor,” she says. “In Tokyo, I can’t think of anything other than work. I’m more than that. My company would be possible in Tokyo — I expanded there in February — but there I wouldn’t be able to run the company the way I want. Fukuoka gives me what I want and how I want it.”

Early success

She hopes to follow FGN’s successful alumni: Alterbooth, a cloud integrator, raised ¥100M ($922K) in June; Authentic Japan, an SOS app that sends rescue drones to users, became mandatory at a major ski resort in April; and Skydisc, an air quality startup with both agricultural and home/office applications, was called a “future unicorn” by Nikkei news service. In all, FGN’s 293 total companies, 21 are established players like local banks and Yahoo, while the remaining 272 startups have pulled in $82 million and lured entrepreneurs from nine countries.

FGN member Kenji Umeki frequents FGN’s ironically named bar, Awa (Bubble), a satellite of a spot popular among techies in Tokyo’s Roppongi district. Umeki named his human resources startup, You Make It, as a pun on his name. His users include Bangladeshi, Chinese, and Vietnamese workers. “Honestly, I have a Vietnamese friend and I just wanted to help him,” he says. “I want that to be a good enough reason for a business proposal.”

Strolling the bank of the curly Nakagawa River, a ¥1-a-day shared-economy umbrella in his hand, Kazuya Shidahara, FGN’s head of engineering events, sits me down with some FGN leaders among Fukuoka’s other great startups: the yatai, the here-and-gone nightly food carts selling ramen, mentaiko, and yakitori. I ask the group what would happen if one of the ramen stands were so successful that it opened locations all over the world like McDonalds or Starbucks. “Like Gong Cha?” asks Shidahara, referring to the Taiwanese bubble tea chain. “Do you know people wait up to three hours there? For what? A tea and an Instagram upload? It’s a trap, a prison. Maybe that’s why they’re called chains.” His words are scalability heresy, but they also call out a Silicon Valley contradiction: its dueling ambitions of ubiquity and unique experience.

Perhaps FGN’s roundabout unorthodoxy can solve a riddle that has been plaguing San Francisco, too — especially the toxic tumult at Facebook, Google, and Uber — while paradoxically paying tribute to an ancient Japanese tradition: Fukuoka is primed to be a beacon of entrepreneurial bushido, the samurai code, helping restore honor and morality to tech (cough, Theranos, that once-celebrated Silicon Valley blood-testing startup that ultimately imploded). Now would be a good time to practice bowing.

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followmeeastward · 6 years

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One night in Bangkok...

(11/12/18) Okay so it was more than one night! But anyways! This past month I was lucky enough to get to travel to Thailand with a large group of my fellow volunteers! We all took to gathering in Bangkok for the beginning of the week, to indulge ourselves in western civilization, then for the last four days of the week, took to an AirBnB on one of the many islands off the coast of Thailand. While I could go on for days with every little detail I’ll give you the highlight reel of the city in this post!

Day Zero (Saturday 10/20) Stepping out of one world into another….

I’ve now been living in Myanmar for nine months, and have grown very accustomed to their version of what a city is, and what western style foods they provide. Nothing was more of a shock on the whole of our Thailand trip than that first drive into downtown Bangkok from the airport. Once again seeing buildings that rise more than twenty floors into the air, and a Starbucks on every corner. I had to consciously remind myself to keep my mouth closed because for the first time in so long I was seeing names of establishments like McDonalds and Subway and I could not contain my girlish excitement. It was like stepping back into any major American city. And it was in seeing this, that it truly felt like vacation had begun, it was a whole new world and a whole new mindset. Couldn’t have made me more excited!

Day 1 (Sunday 10/21) A Day of Shopping:

We woke up from our first night’s sleep and decided that we would go to Chatuchak Weekend Market. It is the largest outdoor market in all of Thailand, definitely a big tourist destination, but at the same time something you do not want to miss. They have everything you could want, from Thai coffee, to mangos and sticky rice, to clothes, food items, pet items, and even pets themselves! Anything you could want you could easily find at this market. It was like an artsy farmers market on steroids. My favorite part about it was how easily a person could get lost, so many different twists and turns, you could be walking for only 10 minutes and find yourself in a whole new section having no clue how you got there! We spent the better part of the day there, trying to hide from the constant on and off showers, splitting our group of 10 into smaller groups, and then randomly running into each other, until we all came to the decision it was time to go back to the hostel.

That night we took ourselves to a place called Best Beef. Which for a price you could get all the meat and veggies you can eat in two hours. Each table had their own grills on them which you would then cook the food yourself at the table! Needless to say our large group got their moneys worth! After that, as we wobbled and rolled ourselves out the restaurant we went to Khao San Road. This is a road that is blocked off, so no cars can go up and down, and is instead lined with bars and clubs. There are also street vendors trying to sell you fried scorpions on a stick and the wonderful ping pong show. No we did not see a ping pong show, if you don’t know what that is, good. It was at a place like this that our group had a killer time! They got me to get up and sing karaoke, where passerby took my video. Then we all danced in the streets to loud techno music with what seemed like hundreds of our new close friends (wouldn’t be the only time this week)! Next thing we knew it was past three in the morning. Definitely time to go back and sleep for a few hours before facing the next day!

Day 2 (Monday 10/22) A Cinematic Cure:

We all woke full day number two not feeling our tip top. But we all gathered and rallied and went to this cool breakfast spot located in the floor above a bar. Inside it looked like a cute coffee shop had been set up at someone’s kitchen table. But the bar downstairs looked like you were walking through the hospital wing at an insane asylum. 50% scary, 50% intriguing. Later that day, my girls Shannon and Maia and myself decided that we would treat ourselves to a movie. A Star is Born with Lady Gaga had just come out, and we thought what better time to go! The movie theater we found had a lobby that looked nicer than some of the top hotels in the states. It was absolutely gorgeous and each theater was HUGE, with recliner comfy chairs, and unlike the theaters in Myanmar, there was FRESH popcorn. It was the perfect hangover cure! That night we went back to the insane asylum looking bar because as it turns out was a craft beer bar! They had beers and ciders of all varieties from all over the world. Even my lovely Ballast Point! We also met the owner who was from Canada but had been in the craft beer business for quite sometime. It was definitely a contrast to the night before, but we were the only people in the bar, so it was nice to get out and have good quality beer in a more low key setting.

Day 3 (Tuesday 10/23) Off to Chinatown:

On our last full day in the city, Paul had a great idea of taking a traditional thai motor boat from downtown where we were staying to where the famous palace is. So me and him, along with Maia and Connor, set off in the morning, after getting our Starbucks on an adventure! It was a whirl wind taking that boat! You sit down in the boat, and its in the water instead of on top of. So when you look over the edge of the boat, you almost at level with the water. Now the waves on the river were very choppy that day and getting on and off you didn’t have much help, so it was a constant game of hoping that you wouldn't stand up and fall in the water. But my favorite part of the ride was getting to see the skyline of the city from a new point of view. We saw buildings of all shapes and sizes, Chinatown, pagodas and other ferry type boat cruises passing by.

We didn’t actually go inside any of the major temples or the palace, because we were trying to save money, instead we walk the length around them before finding ourselves in a nice gated park trying to beat the heat. It was there we decided to go into Chinatown for lunch and just to have a look. Upon entering Chinatown it looked very similar to that of the one in San Francisco, just flat. Each establishment was hanging red lanterns, all around you were Chinese symbols advertising different things on different store fronts. After a wild ride getting there watching our driver dodge traffic we found ourselves in the middle of another rain storm.We decided there to turn down what looked like a covered road that was also lined with everything from food stands, to snack shops, to trinket shops. It was down this road that we found the best food I had had in a long time. We got gyoza, pork buns, fried rice, ramen noodles, and all of us got drinks besides water, all for the equivalent of around ten American dollars. It was a tiny hole in the wall place, that if you asked me to find it again I would never be able to. It was truly the best. Everything so fresh and no tourists, that’s how you know it’s good, when it’s all locals.

By the end of the day when the four of us had reached our hostel once more, we had taken four different modes of transportation throughout the course of the day, Paul had broken his shoes, and we were soaked in rain water. Perfect way to say thank you and goodbye to Bangkok. Because the next morning we’d be off to the island!

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kristinsimmons · 6 years

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The Barbershop Study: How an Unorthodox Study on Black Men’s Health Brought Down the House”

By ANISH KOKA, MD

The study that changed everything was published last week. An alien visiting the national cardiology meeting in Orlando may have thought that the trial of note was the one that featured the culmination of one hundred years of lipid research to develop an inhibitor of the enzyme PCSK9 (Proprotein convertase subtilisin/kexin type 9) that lowers lipids and reduces the risk of future heart attacks.

The Martian would be wrong.

The trial that has cardiologists across the land choking back tears is a hypertension study done in black barbershops. The idea is fairly simple. Black men have the highest rates of disability related to uncontrolled hypertension, in large part related to a difficulty in engaging black men with the health care system. The end result of poorly controlled hypertension in this community was on full display where I did much of my medical training as a student and resident in the heart of North Philadelphia. Ensconced in the walls of Temple we learned to manage the end organs ravaged by hypertension. I have to say I never stopped to think what we could have done to interrupt this process even though we were located in the heart of an underserved black community.

Luckily, Ronald Victor has been thinking about this problem for some time. A Cedars Sinai physician, his research focuses on community interventions to rectify health care disparities. His first study in 2007 sought to examine the feasibility of blood pressure screenings in black barbershops because this was where black men congregated and may be susceptible to influence by important peer influencers: barbers.

The 2007 study by Victor proved that it was feasible to enlist barbers to measure blood pressures, correctly stage hypertension, and make a referral to a clinician for treatment. This opened up funding for the next step in the process- actually affect blood pressure control in barbershops. The trial was wildly positive. In stark contrast to the multibillion dollars of research that lead to a $1000/month PCSK9 inhibitor that gives us a 15% relative risk reduction of a composite outcome of stroke/death/heart attack, the Victor barbershop protocol resulted in a staggering average 27mmHg blood pressure drop in 6 months. The potential ramifications are large for a 20mmHg drop – a 30% reduction in risk of a heart attack or a 40% reduction in risk of a stroke.

This type of low tech intervention is catnip for a public health community committed to the idea that the health of the individual is a function of the structural determinants and conditions in which people are born, grow, live, work and age. This is what is supposed to lie at the heart of the zipcode disparity that results in healthcare outcomes frustratingly equivalent or worse compared to the rest of the world despite per capita spending that is multiples of other developed countries.

If America is to have better average health at low cost, it will not be achieved by the 70 year old heart attack survivor being prescribed the latest $1000/month lipid lowering agent, or by Starbucks latte sipping 55 year olds with a fitbit, but with low tech nudges to poorly performing communities.

The barbershop intervention would seem to be the anecdotal trial that proves the social determinants of health principle – design a healthcare system focused not on the fire burning the house down, but on flame retardant construction material.

I read the trial as a hopeful skeptic because of my failure with patients like Harry White.

The most striking aspect of Harry is his size – six foot five, three hundred and thirty pounds. I met him 5 years ago after he had suffered a small stroke. An echocardiogram had revealed a weak heart, with a blood clot comfortably nestled at the apex. The weak heart was thought to be related to uncontrolled hypertension that he freely admitted he had sought no treatment for in years. He had no insurance, but he had some help. He was plugged into a health center that would help him get blood work and medications for free, and I offered to see him in my clinic without insurance to manage his hypertension and heart failure. He made a few visits to my office over the next year – but then disappeared, only to emerge 4 years later again off of all of his medications. My attempts to find out what would help him return to the office more regularly were spectacularly unsuccessful.

The thing with Harry that was especially frustrating was that his healthcare access problem was a self made one. He had a good, motivated young physician working for him at a federally qualified health care center who worked to get all his medications for him at no cost, and perhaps somewhat less importantly had easy access to see a cardiologist as well. He had on a pair of new jeans, an untucked and oversized button down shirt as is the fashion, a pair of barely worn sneakers, and a big silver framed watch, all of which projected a man who had things under control.

Yet when Harry spoke, he spoke of a system that controlled him. My office wouldn’t give him an appointment (he never called and didn’t want to make one while he was in the office), his primary wouldn’t fill out a form to allow him to return to his prior job (the form was filled out multiple times), and he couldn’t afford his medications (his primary would get him medications for free). It was like he was living in an alternate reality. A broad coalition waits for Harry to reach out. He seldom did. This disengagement, this idea that every problem is a creation of someone else, is widespread. The McSalad Shaker must have disappeared from the McDonalds menu because a high level executive didn’t get the memo about featuring only unhealthy choices to poor communities, not because consumers avoided picking the option. This may also explain why I have been waiting in vain for the kale-avocado Mcflurry. Damn you, Ronald.

Bad choices would seem to lie at the heart of many things in life, and health care is no exception to this.

Of course there are no absolutes, and there are plenty of patients of mine from the same zipcode as Harry that I have broken through to. I’d like to believe this is because of something special I did, but its easy to recognize these patients as folks who were looking for someone to engage with. I just happened to be Johnny on the Spot.

So when I read about care via black barbershops, I was intrigued. The premise that barbers are peer influencers that may have more currency with Harry than the average brown man in a white coat waiting in a clinic is a good one.

The study screened for black men at barbershops who were regular patrons (≥1 haircut every 6 weeks for ≥6 months) with blood pressures at two separate screening visits > 140mmHg. Men were randomized based on their barbershop. Initially the study was powered based on the assumption that 10 barbershops would recruit 25 men each. Because the total number of patrons per barbershop were significantly lower than expected, the number of barbershops were increased and low enrolling barbershops were clustered into groups.

Of the 4500 black men screened, only 10% made it to their second screening blood pressure check in the intervention arm. Most of the dropoff was because many did not have elevated blood pressures on their first visit. Of the ~500 that made it to their second screening visit in the intervention arm, 25% had a systolic blood pressure < 140mmHg on their second visit, 25% were lost to follow up, and 25% declined participation in the intervention arm. In the end the intervention group was left with 139 men with uncontrolled hypertension.

78 barbershops began the trial, 26 (35%) were ultimately excluded because they enrolled 0-1 patients. One of the barbers exceeded expectations by enrolling four times the number of expected participants, and perhaps as a result has one more publication in the New England Journal of Medicine than I have (fourth author on this study). It may be that not every barber and barbershop are equivalent as peer influencers when it comes to hypertension or it could be that the barbershop clienteles differ in their receptiveness to discussions on health (by zipcode?).

The original trial design called for barbers to measure blood pressures and recommend follow up with pharmacists. The pharmacists were to meet with participants at barbershops, encourage lifestyle modifications and prescribe medications via protocol. Unfortunately, the barbers proved inconsistent in measuring blood pressures (they do have a day job after all), and the pharmacists had to take over measuring blood pressures midway through the study. The protocol was also adjusted so pharmacists could use a point of care lab assay to monitor electrolytes and renal function to save participants from trips for labs.

Though the trial was intention to treat, and retention in both arms was fairly good, the intervention arm did have seven patients lost to follow up. We know nothing about their blood pressures at 6 months, and we also know nothing of the clientele of the 26 barbershops that were unable to recruit more than 1 patient.

The results in those ultimately completing the trial were impressive – an average of a 27mmHg drop in the intervention arm compared to a 9mmHg in the control arm relegated to standard of care at 6 months.

Recall, however, that the point of this trial was to assess how effective barbers could be at changing behavior. The news here is mixed. Twenty six of the barbershops were ineffective at recruiting more than one patron. Fully two thirds of the patients eligible for blood pressure control did not follow up despite a variety of supernormal inducements present to participate – vouchers for haircuts, money for pharmacist visits, exhortations from peer influencers, and care delivered at a location administered by two full time pharmacists.

It is entirely likely, that the expanded screening did identify a group of motivated black men that has stayed out of clinics like mine. But Victor already showed this with his study in 2007. This particular study needed to show the feasibility of barbershop/barber- directed blood pressure control. It, unfortunately, did not quite do that. This study essentially shows that a health care system that moves itself into barbershops is effective in one third of men found to have poorly controlled blood pressure. I’m also fairly sure a pharmacist in my living room will improve my lipid profile. And it bears repeating, that despite this herculean effort, two-thirds of black men chose not to connect with a healthcare system that was in their barbershop. You can go ahead and put money on the odds that Harry White remains out of reach – its one you’ll win 66% of the time. I’ll also point out the study duration was six months – Harry had shown up like clockwork for 6 months after his stroke before disappearing.

No trial is perfect, but the hype that surrounded this trial given the limitations would have made MGM proud. One would think the terrors of evidence-based medicine that routinely devastate pharmaceutical companies for things like unplanned protocol adjustments are silent about protocol changes clearly designed to increase the size of the treatment effect of the intervention.

Regardless, I’m not an absolutist, and applaud the achievements of the investigators in doing important work to improve the lives of members of a community that disproportionately bear the ravages of uncontrolled hypertension.

I do take issue with this idea being sold as a scaleable, practical solution for many. In most spaces, intriguing ideas that don’t have a working business model die. In health care policy, however, there is no such thing as an idea that can’t be funded. Academics dream up interesting sounding constructs that satisfy a certain value system, and politicians follow through by assigning money they don’t really have to these bloated edifices.

This particular model is an especially impractical one: two full time pharmacists with the ability to get labs at the point of care only focused on hypertension for 180 men? In the future, I suggest one nurse practitioner for prostate cancer, one physician extender for atrial fibrillation, and at least two providers for diabetes. It should strike most as absurd that after dismissing and destroying the ability of the neighborhood doctor to survive, policy makers would rush to believe innovation comes in the form of an assortment of providers working in barbershops. I understand that there may be a deep rooted distrust of the healthcare system rooted in America’s segregated past that may need to be overcome, but this is best done by having one of the barbershop patrons be a physician with an office down the street. That this has not happened organically in underserved communities to date is a matter that merits discussion, but there should be little debate that policies most recently forwarded by liberals has snuffed out the independent physician.

While health care access is far from ideal, the idea that there aren’t health care options for poor underserved communities requires some context.

Hospitals in Philadelphia

There are five major academic hospital centers located in the city, in addition to a host of smaller community hospitals that take care of patients regardless of insurance in their inpatient facilities. For those underinsured or uninsured patients that can’t get access to the nonprofit academic medical centers outpatient facilities, a bevy of well scattered federally qualified health centers with physicians, nurses, social workers, and case workers awaits to deliver services for free. It may not be at the white glove level of a pharmacist in the barbershop, but it is certainly far from a desert of health care options.

Health Centers in Philadelphia

Harry’s problem is that he has bought into the idea that he has as much control of his own health as a twig being carried by a stream. While appreciating the disadvantages the circumstances of birth has to offer, it seems unlikely we will make folks active players in their own health through interventions designed to promote passivity.

There are no easy solutions to healthcare disparities centuries in the making. The brilliant W. E. B. Dubois, addressing the plight of the black community in 1906 wrote: “with improved sanitary conditions, improved education, and better economic opportunities, the mortality of the race may and probably will steadily decrease until it becomes normal.” It strikes me that Dubois understood that better health was a result of education and wealth. One hundred years later, our obsession with healthcare threatens the economic health of the nation. Moving healthcare into barbershops may get us closer to some patients, but moves us ever further away from the efficient, effective health care system we all want.

Anish Koka is a cardiologist practicing in Philadelphia. He can be reached on twitter @anish_koka

The Barbershop Study: How an Unorthodox Study on Black Men’s Health Brought Down the House” published first on https://wittooth.tumblr.com/

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fadingfartconnoisseur · 6 years

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My Worst Travel Moments of 2017

Travel isn’t only about the good times. Don’t be fooled by the perfect photos and smiling selfies — behind all the awesome times on social media are the times when you’re racing for a flight and terrified you’re about to miss it. The times when you’re sick as a dog and can barely drag yourself out of bed. The times when you’re lonely, missing good times at home. And the times when you’re frustrated at trying to order food that you end up at McDonald’s.

I like to write about those times every year because it’s a good reminder that travel is not a panacea to all of the issues in your life. If you have problems at home, the road could potentially make them worse. Some of my bad times?

In 2012, I got my credit cards hacked while in Portugal and Spain.

In 2013, I developed giant hives in Busan, South Korea, and it was nine months before they stopped popping up on a daily basis.

In 2014, I got head lice in New Orleans. Because clearly I am a small child.

In 2015, I got locked in a vestibule with a cockroach in Avola, Sicily, and had to call my Airbnb host to set me and my mom free.

And in 2016, I fell backwards and slammed my head on the bedpost in Passau, Germany, giving me my first concussion ever and necessitating a hospital visit in Munich.

2017 wasn’t one of my worst years, but plenty of shenanigans ensued along the way. Here are some of my bad times that I took with the good.

When a Piece of my Car Fell Off in Key Largo

For my second trip to the Keys this year, I was to fly into Miami and drive down to Key West before flying back. I picked up my rental car with no issues and drove through Miami for the umpteenth time that year.

Until the next day when I got to the drive-through Starbucks in Key Largo. Then I suddenly noticed a scraping noise everywhere I went.

As I pulled into a parking lot, looking for a good photography spot, a lady called out to me and pointed out that a piece of my car was dragging beneath the bumper. At that point I was about a mile from my guesthouse, so I decided to pop the plastic back into place as best I could and drive back.

It held, but soon enough it popped out again. I called the rental company. Their response? “We can get you a new car, but we’ll need to take you up to Miami and do it there.”

“I can’t come up to Miami,” I told them. “That’s three hours round-trip. I’m working. Why can’t you bring me a car?”

Turns out that was literally the only option.

After thinking about it carefully, I decided to tempt fate and borrow the guesthouse’s roll of duct tape. One of the guests insisted on helping me tape it up.

And wouldn’t you know — it held in place for two more hours, all the way to Key West.

I was terrified the whole drive, though. Never again!

The Chaotic Arrival in Russia

I’m glad I did the St. Peter Line Ferry to Russia, but I’m never doing it again. The main reason? It was completely disorganized and I had no idea what was going on. That didn’t compare to the arrival in Russia, though — it was utterly CHAOTIC upon arrival.

There were supposed to be lines at the arrival booth but everyone just swelled into a pile of lumps, pushing each other out of the way. Parents let their late arriving adult children cut ahead of others. I thought a fight would break out at one point.

And of course I ended up getting questioned for 20 minutes about my heavily worn passport filled with stamps. They were shocked that I planned to stay in Russia overnight. I had to point out that the ferry wa staying for two full days! At one point I didn’t think they were going to let me in at all.

And then I got in, and St. Petersburg was absolutely lovely…but I’m never coming by ferry again.

I will also say that my worst sleep of the year was on the St. Peter Line Ferry. Nothing like trying to sleep in what feels like an undersized twin bed as springs dig into your back and “Y.M.C.A.” blares from the nightclub right above your room…

Killing My Computer in Vail

After five years with one computer, I knew it was time to upgrade soon. Even so, I wasn’t ready for the decision to be made for me against my will.

While at my hotel in Vail, I lifted up the lid to the water bottle, forgetting that it had water in it, and it leapt out and splashed across my keyboard.

I freaked out. I turned it off, dried it out, let it evaporate. But 24 hours later, the top row of keys on the keyboard refused to work at all. And I couldn’t even get on my computer because it wouldn’t let me type my password.

The good news is that I was prepared for this and had the money saved up — even if I got it fixed, it was time for a new computer anyway. After consulting my friends in the Travel Blog Success group over which computer to get, I found a 13″ refurbished MacBook Pro and had it shipped to the Upper West Side store right away.

You know what else I bought? A silicone keyboard protector. Now that lives on my keyboard 24/7 just in case another spill is in my future.

Almost Being Late Back to the Cruise in St. Maarten

(Yes, I’m using this photo for the third time in two weeks. I can’t write about St. Maarten without sharing this photo!)

I like to be early. I like to leave extra time. For me, one of the worst feelings in the world is feeling like I’m going to be late for a flight.

So when the bus dropped me in Maho Beach and I asked about return buses, an the locals said, “It comes when it comes,” I thought I would have to leave extra early to get back on time, just in case.

But then I decided to loosen up. See more of those amazing take-offs and landings before being forced to return to the ship.

Which seemed okay…until I got a cab and the roads were filled with bumper-to-bumper traffic.

St. Maarten, at least on the Dutch side, is basically one main road. If that road is stuck, everything is stuck. And when the ride that took 20 minutes on the way there took closer to an hour on the way back, as time clicked closer and closer to the time that THE CRUISE WAS SCHEDULED TO LEAVE, I began to full-out panic.

My passport was on board. What would I do?! How long would they hold the boat for me, just in case?! When the hell would I get my stuff back? Where would they even send it?! My blood pressure was through the roof.

It was just after the time when I got back on board. God, I was relieved to make it back on time. I practically kissed the crew.

I later found out there had been a regatta that day, hence the traffic. And everybody had been caught up in the same gridlock as us, though the tour groups to Maho Beach had left much earlier as a precaution.

Never again, NEVER AGAIN, am I cutting it that close.

When I Got Attacked by Russians Online

Definitely the worst tech headache this summer was when my site got attacked by Russian networks. And I wasn’t the only one — some of my blogging colleagues were hit as well. Just like the DNC!

Basically, they were sending tons of shitty traffic to my site, trying to overload it. This also temporarily halted my display income as the traffic was so low quality.

Basically, it took a LONG ASS TIME for it to be fixed. But I will give credit where it’s due — it was the team at Sucuri who finally figured out how to block the traffic. If you’re a blogger, I highly recommend their services. It just costs $9.99 per month.

Additionally, today my site is hosted with Performance Foundry. While I’ve used different hosting companies for different reasons over the years, I’m now glad to be with PF because They Can Handle The Bad Shit and I get to worry a lot less.

Not Knowing How to Start My Car in Oulu

I haven’t had a car since 2008, when I moved from Somerville to downtown Boston. Since then, the only times I drive are when I’m home visiting my parents or when I rent a car for a trip, so it always surprises me when I see new high-tech features in cars.

Some of them are great (I love the lumbar support button in my dad’s new car!). And some are bewildering. Like trying to turn it on in the first place when there isn’t even a slot for the key. How does that work?!

It was the morning after my all-night party at the World Air Guitar Championships in Oulu, Finland, and I had to pick up my rental car and drive five hours across the country to Kuopio and then Porosalmi.

It was hard enough finding the right place — the rental office wasn’t open that day, so I had to be driven to a different location. The rental car employee dropped me off at the car with the keys and left.

I loaded up the car. I adjusted the seat and mirrors. And for the life of me, I couldn’t figure out how to turn on the car. HOW?! There was a button, and it definitely turned things on, but it was quiet and didn’t seem to be working — isn’t this how hybrid cars were now?

After fifteen minutes, I was nearly in tears. Nothing was turning the car on.

Finally, an older woman came out of a nearby apartment building and I begged her to help me. She pointed out the obvious — I was supposed to step on the break while simultaneously pushing the ignition button. The engine roared to life.

“Kiitos. Thank you so much,” I told her. “You’ve saved me.”

“You’re from America?” she asked.

“Yes,” I said. “New York.”

“My daughter lives in Houston.”

And just for the record, that’s the Finnish equivalent of a deep, intimate conversation. I love that introverted country.

Every Minute I Wasted on the Landmark Forum

Have you heard of the Landmark Forum? Google it and you’ll find people calling it a cult.

I haven’t written about the Landmark Forum in depth, and I’m still wrestling with whether I should write about it in detail. Maybe someday I will.

It’s a personal development seminar. I ended up there because a friend who had done the Forum invited me to do it. It had changed her life and she thought it could change mine, too.

As the days passed (it was a four-day event), soon it became clear that this wasn’t working for me. I wasn’t having the breakthroughs that other people seemed to be having. The “big revelation” was a phrase you’d expect an emo kid to scrawl on his biology book when he was trying to be edgy.

But that wasn’t all.

What brought me over the edge was when the instructor told a story about how they welcomed a child molester to the Forum with open arms. And apparently when a young woman brought in the relative who sexually assaulted her repeatedly as a child, everyone was cheering because he had made this decision to change his life.

I immediately went up to the microphone and let loose. How could you let a child molester into a room full of sexual abuse survivors? Did they call the police? How could this possibly be framed as a good thing? Did they want his money so much that it didn’t matter that he was a child molester, sitting amongst them?

For the first time in three days, the instructor was caught off guard.

After I spoke, the Landmark Forum offered me a full refund of $695.

I think that says it all.

For the record, I don’t think the Landmark Forum is a cult. However, I do think that they use many techniques that cults use. They instill a belief that everyone who hasn’t gone through the Forum will never be as good or evolved as people who have gone through the Forum. Every minute is controlled with almost no downtime; you have assignments to do on your breaks and you work from 9 AM to 10 PM or later. All doubts that attendees express are swiftly countered and shut down by the instructor. They encourage you to recruit everyone you know to join the Forum. There are several other courses afterward that they encourage you to keep taking, all of which cost additional money.

And while they make it seem like everyone loves it, the people above in the photo attended my Forum and didn’t get anything out of it, either. The defining mood was, “What the hell did I just spend $695 on?” It felt amazing to confess to each other that we were creeped out by the whole thing.

So yeah. Besides the friend who recruited me, I have several other friends who have done the Forum in various cities and countries and it did work for them. And they’re all great people, smart people, educated people. But the more I think about it, the more I realize those people share a number of personality traits that I personally do not have.

So would I recommend it? No, I would not. But who knows? Maybe it would work for you. I wouldn’t recommend you spend $695 on as big a gamble as that, though. And if you go, for God’s sake, don’t welcome a pedophile with open arms.

The Weird Ass Table Next To Ours in the Hamptons

On a day trip to the Hamptons with my friends Beth and Colleen, we decided to get dinner at Almond in Bridgehampton. The food was fantastic (their lobster pasta was one of the best dishes I’ve had all year) but the experience was ruined by this odd experience with the table next to ours.

They were a bunch of gay guys our age, several drinks into their night. One of them turned to Beth and said something like, “Sorry our friends are drunk,” and Beth said something back like, “Oh, that’s fine with us.”

They MUST have misheard her, because there’s no other explanation for what happened next.

The men suddenly started glaring at us, saying rude things about us to each other. Then one leaned over and said, “You’re in town for the weekend? Oh, that’s CUUUUUTE. I live here.”

What the fuck?!

Here’s the thing: I felt afraid, and I think my friends may have felt the same way. We were frozen, looking at each other with giant faux smiles on our faces, afraid of what they would say if we said anything. And you might think that there was no reason to be afraid, that we were in the middle of a restaurant, that these guys were gay anyway and it couldn’t possibly lead to sexual assault. It wasn’t about sex — it was about power, just as all sexual harassment and assault is. These men thought we didn’t belong in their space and they wanted us to be afraid of them.

Every time we talked or laughed, the guys would swivel their heads in our direction, angry expressions on their faces. One guy even slammed his head on our table and pretended it was an accident.

The men left the restaurant when our entrees came and as soon as they were gone, we exploded. What was their problem? Why would you treat strangers like that? What did they think Beth had said? I still have no idea what happened all these months later.

A Day of Delay Hell in Charlotte

On the way back from Asheville, I had a layover in Charlotte. That two-hour layover turned into ten hours and counting. And it wasn’t an ordinary layover — there were thunderstorms in New York, so they kept delaying it by an hour, another hour, yet another hour, every hour, then canceling the flight, then delaying the rebooked flight. If I had known, I would have gone out into Charlotte to explore! Hell, I would have taken a later flight from Asheville!

Charlotte is not the greatest airport in which to be stranded. Less healthy food, far less bookstores, yet a lot more fast food. If you end up stranded there…yeah, good luck with that.

I was supposed to be home by 4:00 PM but I didn’t get home until 1:30 AM. Worst transit day of the year.

Finding Out I Had to Move

On the last day of November, hours before I was to fly to Vegas, my landlady told me that she was selling the building and I had to move.

This was the last thing I wanted to hear. I adore my apartment and wanted to continue living there for at least another year or two. Plus, not only is moving in New York annoying and expensive, but it’s even tougher for self-employed people. New York tenants have a lot of rights, so to counter that, they make it difficult for people to rent in the first place. For example, you need to prove income of 40 times the monthly rent in a year. And even if you make that much, a lot of landlords are skittish about renting to self-employed people.

I was so nervous, I didn’t eat or sleep for a week. I got stress headaches. I had no appetite. I couldn’t do anything at the gym.

That said, I was able to remedy the situation quickly. I set up apartment viewing appointments within an hour of the news. I applied for the second apartment I saw. And thankfully, after a lot of work and sleepless nights and sending every proof of income that I had, I was accepted into a new apartment extremely close to where I live now.

The new place is great. It’s not a brownstone anymore (now that I know how easily brownstones can be sold out from under you, I’m a bit over brownstone living), but it’s a much bigger, gut-renovated apartment with tons of closet space and a separate kitchen. Moving day is January 15, and I can’t wait to share my new place with you.

A Sexually Harassing Driver in St. Kitts

Picture this: you get off your cruise ship in St. Kitts for the day. You decide to eschew a shore excursion and instead hire a driver for the day. This will give you a chance to explore and take all the photos you need without having to confirm to a schedule.

So you step into the driver’s van. And before he’s even left the parking lot, he’s leaning out the window and yelling sexual things at a woman walking by. She ignored him. I practically had flames bursting out of my ears.

“But it’s the Caribbean.”

It’s not just the Caribbean. It’s fucking everywhere.

THE RAINDROP CAKE WAS A LIE

I know a lot of New York/Instagram/Buzzfeed food trends are overblown, but nothing was as bad as the raindrop cake, which I sampled at Smorgasburg in Prospect Park, Brooklyn. I had been seeing this for weeks: it was a clear orb, yet something that you ate like a cake.

Beth and I decided to try them: one clear, one purple. We each forked over eight dollars, hoping that this would be worth it.

We sampled them. And…they were essentially plain sugary gelatin.

I felt like an idiot. How had I built this dish up so much in my mind? Did I really think it would be as cool as the Instagrams and Buzzfeed articles claimed? HOW FAR HAD MY MIND GONE IN THE NAME OF EATING TRENDY FOOD?

There is so much good food at Smorgasburg. I especially recommend the fries from Bolivian Llama Party. But make sure you avoid the raindrop cake.

What were your worst travel moments of the year?

The post My Worst Travel Moments of 2017 appeared first on Adventurous Kate.

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cubaverdad · 7 years

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Cuba was the opposite of everything I imagined

'Cuba was the opposite of everything I imagined' JANUARY 7, 20175:35PM Kirrily Schwarz news.com.au BARACK Obama's visit to Cuba in March 2015 was historic, marking the end to decades of hostility between the two nations. Just five months later, in August, the first commercial flight left American soil for Havana, opening the island to mass tourism. It's become one of the world's hottest destinations, with many rushing to visit before McDonald's and Starbucks appear on every corner. Most reviews are glowing — painting a picture of a time-capsule with excellent food, cheap drinks, beautiful beaches, lively culture and friendly locals. OK, infrastructure is lacking and there's hardly any internet, but so what? For Tahsir Ahsan, it became a very big deal. The 24-year-old travel agent recently visited Havana, penning an article called: "Cuba is actually a terrible place to go". He planned a spontaneous trip with two friends, and thought he'd check out the city for a few days, but he ended up bailing almost immediately. "We were there exactly 27 hours, we got there at 4pm from Miami, and left at 7pm the next day," he admitted to news.com.au. "I knew there would be no internet, and to be honest I wasn't even looking for internet. The only reason I needed it was because so many of our plans started failing." First, their bags never made it to Cuba, and not one of the people they asked at the airport knew where the baggage office was. When they were trying to find a representative from their airline, they noticed a group of people were trapped in a glass lift, banging on the door. "I quickly ran up to the desk and informed them that I thought people were stuck in the elevator to which the lady just responded, 'Yes.' I chose to fight my own battle," he wrote. Second, they booked a non-existent Airbnb. When they told the taxi dispatcher the address, she said it didn't exist, and when they called the number attached to the booking, the phone had been disconnected. "Myself and my friends, we took about $US600 dollars (A$817) each for two or three days. We weren't able to use credit cards or ATMs, but other people told us that should be enough," he told news.com.au. "When our Airbnb fell through, the hotel was $600 a night. Eventually we found a casa particular (a private home that rents rooms) for $45 a night, but then we had baggage issues. The airline said we should just buy what we needed and they'd reimburse us, but we were worried about running out of money. "That's why we left so quickly, we needed to get somewhere we could use our cards." Mr Ahsan first became interested in visiting Cuba when he heard it described as a "time-warp". However, the reality was more decrepit than romantic. "The roads are just terrible, they're crumbling. The pollution is terrible because the cars are so old, and it just smelled like a gas station. "I expected it to be lively, in that there's a lot of culture. Throughout the day, most of it seemed more like just another city. Everyone was just going about their business." The hosts at the casa particular gave tips on what to eat and where to go. "Everyone was really friendly, I wasn't expecting that. We were told Cuba is a country that kind of oppresses their people, but everyone was extremely friendly and they didn't hassle us or anything like that. They were all willing to help." However, food was another tremendous disappointment. The walk-up restaurant his hosts recommended was tiny, and the line was so massive they couldn't see what food was being served. "It turns out it was hot dogs!" he laughed. He and his friends opted to pass, and ended up wandering around until they stumbled on a hotel restaurant. "At 11 o'clock at night, not much was open, so we ate there. They had burgers, spaghetti, pizza — they didn't have any Cuban dishes, just international cuisine," he said. His friend ordered spaghetti, but the sauce was so bad it was inedible. Keen to avoid the same experience, Mr Ahsan ended up eating plain white noodles. The next morning, they were keen to have a totally different experience. However, their accommodation was fully-booked, so they had to find a new place to stay. A quick survey of nearby hotels and casas particulares revealed every single room in the area was also sold out. "It was a comedy of errors," he told news.com.au. "It kind of goes to show that Cuba itself has been blockaded by the US for the past 50 or 60 years, but they've been open to everyone else for years." He and his friends made an executive decision to bail, booking tickets that afternoon for Cancun in Mexico. It's a well-developed tourist hot spot, often considered to be an equivalent to Bali in terms of beaches, cuisine and partying. Mr Ahsan said he wouldn't rule out a return trip to Cuba, but in lieu of basic infrastructure such as internet, he'd be much more organised. "Six of my friends were actually in Cuba at the same time, but I couldn't organise to meet up with them unless we were online at the same time. "Don't try to go there and wing it, because it's not that kind of country. I'd probably go back later, with someone who's gone a lot of times so I could experience it differently." Source: Cuba travel: It was the opposite of everything I imagined - http://ift.tt/2iU5z4t via Blogger http://ift.tt/2iTW8Ck

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kristinsimmons · 6 years

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The Barbershop Study: How an Unorthodox Study on Black Men’s Health Brought Down the House”

By ANISH KOKA, MD

The Martian would be wrong.

I read the trial as a hopeful skeptic because of my failure with patients like Harry White.

Bad choices would seem to lie at the heart of many things in life, and health care is no exception to this.

While health care access is far from ideal, the idea that there aren’t health care options for poor underserved communities requires some context.

Hospitals in Philadelphia

Health Centers in Philadelphia

Anish Koka is a cardiologist practicing in Philadelphia. He can be reached on twitter @anish_koka

The Barbershop Study: How an Unorthodox Study on Black Men’s Health Brought Down the House” published first on https://wittooth.tumblr.com/

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