Saturday, April 14, 2012

Algeria: Looking for a good sit-down

At the residence I discover my toilet doesn't actually work. It pretends to, but the tank doesn't refill.
Nor do I have any kind of clock and this isn't an ordinary hotel with a clerk to ask for a wakeup call. In the early hours, sometime after the long calls of the muzzein and before proper light, we have a nice little earthquake. I'd give it a 4. Apparently they're not so common here, and it's the talk of the day.
The schedule says the first talk is at 8 am, so I'm up with the sun. I've never seen a congress start so early. But never fear. No need to rush. At 9 the group is just starting to consider getting into the cars and going over.
We start the first talk at 10, when we should be starting the coffee break. My host asks me if I'll be giving my absent boss's talk as well as my own. Er, well yes I did expand my talk to cover some of the missing information, but I really don't know what all he intended to say.
At any rate, I save us a bit of time, but by 11:30 when the moderator announces there will be no pause (so we can catch up, and break for lunch before dinner!), I go out anyway for a bathroom break. This apparently opened a floodgate, because when I emerge from the so-called bathroom, people are streaming out of the ampitheater in search of refreshment.
[note to self: find a toilet worthy of the name and plan accordingly. The one next to the dining room at the residence is good but usually locked. The university ones are pits with no paper and a flush system that gets the whole cubicle wet. Why on earth did they install such a disgusting and poorly-functioning system in a spanking new building?? At a minimum, from now on I keep a supply of paper in my pocket at all times.]
The sensation of the meeting is a tag-team of two guys from France come to expose large-scale mammographic screening as completely useless. Their position is that the increasing incidence of breast cancer worldwide is 100% attributable to finding non-symptomatic tumors that would never have become a problem. Mortality from breast cancer has not really changed, and so doctors are patting themselves on the back for lowering the percentage that ends up being fatal. Breast cancer is skyrocketing, but look - we're holding the line on mortality! But think: if you're inflating the incidence with useless diagnoses, have you really improved survival for the unchanged core of serious cases? Bernard J and Bernard B are here to tell us it's all a ruse put on by Big Pharma and the Medical Machine.
The reality has to be somewhere in the middle. Yes, breast cancer can disappear on its own. Yes, some tumors just never evolve, they just sit there for years. Yes, screening picks up all sorts of suspicious lesions that we can't tell in advance what they're going to become. Yes, we are pushed be the business of medicine, pharmaceutical companies, and a litigous public to screen early and often and without any independent evidence of pathology.
But some of the increase in breast cancer indicence is real. Our protective factors are disappearing fast:
- physical activity
- healthy environment
- early and multiple births
- long periods of breastfeeding
- late menarche and early menopause
So it's right to question the pertinence of widespread screening as well as when to start, how often to do it, and what techniques to use. But don't just say Forget the whole thing. Not yet.

The official dinner is in another restaurant, again with a separate room with traditional decor for the VIPs - all cushions, rugs and taxidermy. This time I eat with friends in the regular dining room, all formica and linoleum.
Trying to wash my hands before dinner, I was probably cleaner just staying at the table. The single toilet for the huge restaurant is utterly inadequate. It leaks, and the entire floor is wet even beyond the restroom itself. The toilet paper gave out long ago, and the paper towels are going fast. I have (thank goodness) arrived before the critical stage where the toilet becomes clogged when people eventually turn to using napkins off the tables. There is at least a large bottle of dish soap for your hands, but we are inevitably tracking the mess everywhere. This is why you leave your shoes at the door when you enter your house.
Dinner is enjoyable. I'm sure if I stayed in Algeria for a month I would start speaking Arabic. The food is not great so it's easy to not overeat for once, though it's rather spectacular when the people at the end ot the table pass their mostly full and precariously stacked plates to the waitress. She doesn't want to take them, having one hand full already with used dishes, but she tries. And fails. And then I had peas&carrots all over my shoes. (what is this international fascination with peas&carrots? in China, in England, in the US, now in Algeria: they're everywhere.)
My friend and her colleagues from various hospitals in cities along the coast are very merry. The laughter never stops, though most of it is in Arabic and the rest mentions people and events I don't know. I do my part for a while, and then am graciously allowed to smile and nod.

In the quiet of my room at the residence, I'm delighted to discover my toilet has been fixed.

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