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A heart-to-heart discussion

STUART WHITE
THE WORLD IN BLACK-N-WHITE

A new law comes into effect in the United Kingdom shortly allowing doctors to harvest organs and other body parts from any patient  dying in hospital unless they have given specific instructions to the contrary.

This turns on its head the previous convention whereby  the donor had to have made known their consent or in the case of not having done, permission would then have to be obtained from members of the immediate family to extract transplantable body parts. Before going any further it’s worth having a look at the history of transplants and the rapid advancement in scope and success. 

Though practitioners of medicine had considered the possibility of transplanting body parts for decades, if not centuries (consider Mary Shelley’s famous 1818 horror tale Frankenstein),  the practice only truly began in 1954 when  Dr. Joseph E. Murray  achieved the first successful kidney transplant between identical twins in Boston in 1954.  Murray received the Nobel Prize for Medicine for this pioneering work  in 1990.

However it was 13 years later when arguably the most ground-breaking transplant was carried out, almost on our own doorstep.   On 3 December 1967 at the Groot Schuur hospital in Cape Town, the heart of a young female accident victim was transplanted into a middle aged man, Mr. Louis Washansky,  suffering from intractable heart failure caused by coronary artery disease. He died 18 days later from extensive bilateral pneumonia but this limited success was hailed throughout the world as a major medical triumph and turned Barnard into an international superstar.

His second transplant on a  Dr Philip Blaiberg, was carried out less than two weeks later. The donor was a young man who had had a severe subarachnoid haemorrhage while swimming.  Blaiberg  survived for 18 months following his surgery.  Many people wondered why the world's first heart transplant came to be carried out in Cape Town, South Africa,  rather than one of the leading centres in the United States or Europe but in fact the standard of medicine in Cape Town in the 1960s was advanced and sophisticated with well equipped research laboratories and an ethos in which research and initiative were encouraged with a staff complement of full time doctors who combined their clinical care and teaching with experimental work in the adjacent medical school, headed by Barnard.

Much damage was done to the image of heart transplantation by the immediate unseemly scramble to get on the bandwagon. In 1968 107 transplants were carried out by 64 surgical teams in 24 countries. These were of poor clinical capabilities, matching of donors and recipients was poor and there was little appreciation of the need for meticulous aftercare and the management of rejection. 

The major problem was the tendency of the body’s immune system to become activated against the foreign organ and to mount a response designed to kill the invader (rejection). In order to prevent rejection, patients were given strong medications to suppress their entire immune system that in turn left them susceptible to life threatening infections. It was not until 1978, when the immunosuppressive drug Cyclosporin was introduced, that many of the problems of rejection were controlled.

Since then, other drugs have been developed and today, one-year survival rates for most organs are between 70% and 90%. As transplant medicine accelerated, it produced a wealth of legal and ethical concerns, the most critical of which related to the determination of death. Technology had improved to the point where the body could be maintained with artificial support long after the brain had died.

A new definition of death was required to include situations where the entire brain and brain stem had irreversibly ceased to function (brain death). This  is critical as it allows recovery before cessation of blood flow to the organs. Prior to brain death, organs could only be recovered after the heart had stopped beating, which limited transplants to kidneys and livers only. Brain death allowed the additional recovery of the heart, pancreas, lungs and intestines, eyes and even skin.

Which brings me back to the new British law.  There is no doubt that there is an urgent need for more organ donation.  400 people died last year whilst on the transplant list in the UK and in the US an average of 20 people die daily and certainly some of those deaths could be avoided if people were compelled to agree to post-mortem donation.  But there is a huge moral and ethical leap being made here which assumes that dead bodies are effectively state property and that is a worrying development.

A huge scandal broke out in the UK in the 1990s when it emerged that organs and tissue from children who died in the Alder Hey and Bristol  hospitals had been harvested and stored for use in research without the parents’ knowledge or consent, yet only a quarter of a century later this is now to become state-sanctioned.  In addition the practise, whilst not specifically banned in any of the major religions, is condemned under differing interpretation of ancient tracts and precepts. 

There is further confusion concerning the terminology and litmus test of ‘brain dead’ in the light of new research on long-term, comatose patients. So a pioneering step in organ donation and potentially life-saving legislation or a massive state intrusion into that most basic possession of the human being – his or her own body?  We might even say that’s at the very heart of the problem.

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The Daring Dozen at Bari

8th December 2020
JEFF---Batswana-smoke-unit

Seventy-seven years ago, on the evening of December 2, 1943, the Germans launched a surprise air raid on allied shipping in the Italian port of Bari, which was then the key supply centre for the British 8th army’s advance in Italy.

The attack was spearheaded by 105 Junkers JU88 bombers under the overall command of the infamous Air Marshal Wolfram von Richthofen (who had initially achieved international notoriety during the Spanish Civil War for his aerial bombardment of Guernica). In a little over an hour the German aircraft succeeded in sinking 28 transport and cargo ships, while further inflicting massive damage to the harbour’s facilities, resulting in the port being effectively put out of action for two months.

Over two thousand ground personnel were killed during the raid, with the release of a secret supply of mustard gas aboard one of the destroyed ships contributing to the death toll, as well as subsequent military and civilian casualties. The extent of the later is a controversy due to the fact that the American and British governments subsequently covered up the presence of the gas for decades.

At least five Batswana were killed and seven critically wounded during the raid, with one of the wounded being miraculously rescued floating unconscious out to sea with a head wound. He had been given up for dead when he returned to his unit fourteen days later. The fatalities and casualties all occurred when the enemy hit an ammunition ship adjacent to where 24 Batswana members of the African Pioneer Corps (APC) 1979 Smoke Company where posted.

Thereafter, the dozen surviving members of the unit distinguished themselves for their efficiency in putting up and maintaining smokescreens in their sector, which was credited with saving additional shipping. For his personal heroism in rallying his men following the initial explosions Company Corporal Chitu Bakombi was awarded the British Empire Medal, while his superior officer, Lieutenant N.F. Moor was later given an M.B.E.

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A Strong Marriage Bond Needs Two

8th December 2020

Remember: bricks and cement are used to build a house, but mutual love, respect and companionship are used to build a HOME. And amongst His signs is this: He creates for you mates out of your own kind, so that you may find contentment (Sukoon) with them, and He engenders love and tenderness between you; in this behold, there are signs (messages) indeed for people who reflect and think (Quran 30:21).

This verse talks about contentment; this implies companionship, of their being together, sharing together, supporting one another and creating a home of peace. This verse also talks about love between them; this love is both physical and emotional. For love to exist it must be built on the foundation of a mutually supportive relationship guided by respect and tenderness. As the Quran says; ‘they are like garments for you, and you are garments for them (Quran 2:187)’. That means spouses should provide each other with comfort, intimacy and protection just as clothing protects, warms and dignifies the body.

In Islam marriage is considered an ‘ibaadah’, (an act of pleasing Allah) because it is about a commitment made to each other, that is built on mutual love, interdependence, integrity, trust, respect, companionship and harmony towards each other. It is about building of a home on an Islamic foundation in which peace and tranquillity reigns wherein your offspring are raised in an atmosphere conducive to a moral and upright upbringing so that when we all stand before Him (Allah) on that Promised Day, He will be pleased with them all.

Most marriages start out with great hopes and rosy dreams; spouses are truly committed to making their marriages work. However, as the pressures of life mount, many marriages change over time and it is quite common for some of them to run into problems and start to flounder as the reality of living with a spouse that does not meet with one’s pre-conceived ‘expectations’. However, with hard work and dedication, couples can keep their marriages strong and enjoyable. How is it done? What does it take to create a long-lasting, satisfying marriage?

Below are some of the points that have been taken from a marriage guidance article I read recently and adapted for this purposes.

POSITIVITY
Spouses should have far more positive than negative interactions. If there is too much negativity — criticizing, demanding, name-calling, holding grudges, etc. — the relationship will suffer. However, if there is never any negativity, it probably means that frustrations and grievances are not getting ‘air time’ and unresolved tension is accumulating inside one or both partners waiting to ‘explode’ one day.

“Let not some men among you laugh at others: it may be that the (latter) are better than the (former): nor let some women laugh at others: it may be that the (latter) are better than the (former): nor defame nor be sarcastic to each other, nor call each other by (offensive) nicknames.” (49:11)

We all have our individual faults though we may not see them nor want to admit to them but we will easily identify them in others. The key is balance between the two extremes and being supportive of one another. To foster positivity in a marriage that help make them stable and happy, being affectionate, truly listening to each other, taking joy in each other’s achievements and being playful are just a few examples of positive interactions.
Prophet Muhammad (PBUH) said: “The believers who show the most perfect faith are those who have the best character and the best of you are those who are best to their wives”

UNDERSTANDING

Another characteristic of happy marriages is empathy; understanding your spouses’ perspective by putting oneself in his or her shoes. By showing that understanding and identifying with your spouse is important for relationship satisfaction. Spouses are more likely to feel good about their marriage and if their partner expresses empathy towards them. Husbands and wives are more content in their relationships when they feel that their partners understand their thoughts and feelings.

Successful married couples grow with each other; it simply isn’t wise to put any person in charge of your happiness. You must be happy with yourself before anyone else can be.  You are responsible for your actions, your attitudes and your happiness. Your spouse just enhances those things in your life. Prophet Muhammad (PBUH) said: “Treat your women well and be kind to them for they are your partners and committed helpers.”

COMMITMENT

Successful marriages involve both spouses’ commitment to the relationship. The married couple should learn the art of compromise and this usually takes years. The largest parts of compromise are openness to the other’s point of view and good communication when differences arise.

When two people are truly dedicated to making their marriage work, despite the unavoidable challenges and obstacles that come, they are much more likely to have a relationship that lasts. Husbands and wives who only focus on themselves and their own desires are not as likely to find joy and satisfaction in their relationships.

ACCEPTANCE

Another basic need in a relationship is each partner wants to feel valued and respected. When people feel that their spouses truly accept them for who they are, they are usually more secure and confident in their relationships. Often, there is conflict in marriage because partners cannot accept the individual preferences of their spouses and try to demand change from one another. When one person tries to force change from another, he or she is usually met with resistance.

However, change is much more likely to occur when spouses respect differences and accept each other unconditionally. Basic acceptance is vital to a happy marriage. Prophet Muhammad (PBUH) said: “It is the generous (in character) who is good to women, and it is the wicked who insults them.”
“Overlook (any human faults) with gracious forgiveness.” (Quran 15:85)

COMPASSION, MUTUAL LOVE AND RESPECT

Other important components of successful marriages are love, compassion and respect for each other. The fact is, as time passes and life becomes increasingly complicated, the marriage is often stressed and suffers as a result. A happy and successful marriage is based on equality. When one or the other dominates strongly, intimacy is replaced by fear of displeasing.

It is all too easy for spouses to lose touch with each other and neglect the love and romance that once came so easily. It is vital that husbands and wives continue to cultivate love and respect for each other throughout their lives. If they do, it is highly likely that their relationships will remain happy and satisfying. Move beyond the fantasy and unrealistic expectations and realize that marriage is about making a conscious choice to love and care for your spouse-even when you do not feel like it.

Seldom can one love someone for whom we have no respect. This also means that we have to learn to overlook and forgive the mistakes of one’s partner. In other words write the good about your partner in stone and the bad in dust, so that when the wind comes it blows away the bad and only the good remains.

Paramount of all, marriage must be based on the teachings of the Noble Qur’an and the teachings and guidance of our Prophet Muhammad (PBUH). To grow spiritually in your marriage requires that you learn to be less selfish and more loving, even during times of conflict. A marriage needs love, support, tolerance, honesty, respect, humility, realistic expectations and a sense of humour to be successful.

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Chronic Joblessness: How to Help Curtail it

30th November 2020
Motswana woman

The past week or two has been a mixed grill of briefs in so far as the national employment picture is concerned. BDC just injected a further P64 million in Kromberg & Schubert, the automotive cable manufacturer and exporter, to help keep it afloat in the face of the COVID-19-engendered global economic apocalypse. The financial lifeline, which follows an earlier P36 million way back in 2017, hopefully guarantees the jobs of 2500, maybe for another year or two.

It was also reported that a bulb manufacturing company, which is two years old and is youth-led, is making waves in Selibe Phikwe. Called Bulb Word, it is the only bulb manufacturing operation in Botswana and employs 60 people. The figure is not insignificant in a town that had 5000 jobs offloaded in one fell swoop when BCL closed shop in 2016 under seemingly contrived circumstances, so that as I write, two or three buyers have submitted bids to acquire and exhume it from its stage-managed grave.

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