For those who do not know my heritage I am Ghanaian by birth and moved to the United States about 16 yrs ago. In the US I have never been able to escape being mistaken for a Nigerian, Caribbean American or African American among a whole host of origins and associations. I have no qualms about this because I do not believe my heritage defines who or what I am. Our genetic heritage outside of the social associations and restrictions that it may imposes upon us does not define or determine who or what we are, or become.

In Charlottesville today there are violent protests between groups on two sides of a perceived racial divide. What makes this situation so sad is that we are fighting among ourselves over the social construct of race. A social divide that we have created and reinforced over centuries to determine allocation of resources and opportunities. Slavery in the Americas is one of the most extreme forms of this social policy. I use the word policy because in those times our laws supported this practice. Today though not supported by law it still exists deeply entrenched in our society. Our society has evolved from slavery into a social system that fosters racial bias with whites at the top of the hierarchy and blacks at the bottom with Asians, Jews and Hispanics somewhere in the between.

Over the ages several writers and philosophers have come out with several theories that try to propagate the belief in white supremacy. Historical accounts that accentuate white supremacy either by design or happenstance have tended to be promoted at the expense of other groups. This has created a strong believe among some white Americans that the resources of this nation should be their one of their inalienable rights at the expense of other groups. This is probably the driving force behind the protests in Charlottesville, VA. I was not surprised to hear David Duke a former KKK leader and a strong supporter of the trump campaign for president comment yesterday on the protests in Charlottesville.  “This represents the turning point with the people of this country, we are determined to take our country back. We’re gonna fulfill the promises of Donald Trump. That is why we voted for Donald Trump, because he said he is going to take our country back and that is what we are going to do”[i]

 Duke’s statement most likely reflects the beliefs of most of the right wing protesters in Charlottesville. When David Duke mentioned taking his country back I could only cringe at his words because, I know a group of Americans who should be singing that tune. The riches and resources of this country have been divided and shared over the years. Historically slavery and post slavery Jim Crows laws have always ensured that the sharing has almost always been unequal with Black Americans getting less of the pie.

Today if there are any groups of Americans who deserve to be taking their country back, it is Native Americans. Unfortunately today Native Americans are a minority on this continent. The sacrifices and contributions of all the various racial and ethnic groups  to the greatness of this country needs to be recognized.

Today I raise a shout to all our, Latino, White, Asian, Native American, African, Jewish and Arab brothers and sisters who are standing side by side in defense of Unity and progress. Today as we mourn the protesters who died at Charlottesville ‘I say you are all great American heroes’. You stood for what America stands for, and you will be remembered by posterity.



[i] CNN Politics; Stories worth watching; accessed on 8/12/2017



After watching the dash-cam video of the shooting of Philando Castile by police officer Geronimo Yanez, I was extremely shocked at the composure and calmness of the late Castile and his girlfriend Diamond Reynolds whilst the trained police officer sounded and acted very much uncontrolled and panicked. This one incident, which has been watched many times over the past year, is really sad and concerning. As a black man I have been stopped many times usually for some traffic infraction and usually get a ticket and occasionally a warning. One of the few times when I got a warning was when I was stopped in s situation similar to the Castile killing. In 2004 a white officer in LaGrange Park, IL stopped me for speeding. I was then driving with my wife while my stepdaughter slept in the back seat. I cannot say why I received a warning on that day whilst Mr. Castile ended up getting shot.  That was the first time I received a warning rather than a ticket for a traffic offence. Maybe it was because nobody had reported a burglary when I was stopped or because I did not report I was carrying a licensed firearm or just maybe my cop was a lot more experienced than Geronimo Yanez and realized that a black man or for that matter any man with his family is less likely to create a situation that could put his family in danger. Another factor may be the neighborhood, maybe Falcon Heights, MN was just more exclusively white than La Grange Park, IL and as such a black person in Falcon Heights would garner more suspicion than in La Grange Park. I have discussed this issue with a lot of people, most of them being black like myself and the consensus was that Philando Castile died for only one basic reason, he was driving while black.

This is a situation while being common and easily identified has roots that go so deep that we continue to have problems with this irrespective of the extensive training given to cops. There have been many other incidents involving cops and unarmed black people usually men, that suggests that just training is not enough. Blacks in America have dealt with a lot over the centuries from slavery to institutionalized racism and Jim Crow laws. Today we are dealing with racial prejudice and a more insidious cancer; implicit racial bias. The problem with dealing with implicit bias is the fact that the person acting out this behavior directed by his or her biases fails to recognize that their actions are based on racial bias. In a recent episode of the podcast Invisibilia a white man who had an adopted black daughter reports catching himself act in a way that he had warned his daughter she may be treated just because of her race [1]. This gentleman realized what he was doing because he is the father of a minority child and re-evaluated his actions. In the real world unfortunately most of us just act out our biases without any thought of what we are doing. When asked if we acted that way because of race we would most probably genuinely say no.

On account of the multiple traffic stops with disastrous outcomes involving minorities Stanford University started a project called The Open Policing Project to study this problem[2]. Since 2015 the program began requesting data on police traffic stops from across the country. To date, the project has collected and standardized more than 100 million records of traffic stops and search data from 31 states. Twenty states provided enough detail in their data to allow statistical analysis to determine racial bias in policing. The findings of this project that I present below is based on data from sixteen states; Arizona, California, Colorado, Connecticut, Florida, Illinois, Massachusetts, Montana, North Carolina, New Jersey, Ohio, South Carolina, Texas, Vermont, Washington and Wisconsin does suggest some racial bias policing. The Open Policing Project data suggest that Blacks tend to get stopped more often than Whites whilst Hispanic are stopped at about the same rates as whites (see the graph below).


Screen Shot 2017-06-23 at 3.49.52 AM

The researchers also went on to look at search rates after a stop and in this case it appears that both Blacks and Hispanics motorists who were stopped were much more likely to be searched compared to whites. This can be clearly seen in the graph below in Figure 2 showing that white motorist were searched in less than 6% of stops with the exception of one outlier whilst Blacks and Hispanic searches ranged all the way up to 10% of stops.


Screen Shot 2017-06-23 at 3.51.02 AM

The above graph though did not account for what factors cops were using to determine whom to search. It is possible as in the case of Trayvon Martin who was deemed suspicious by John Zimmerman because he was wearing a hoodie that the black and Hispanic motorist just plain appeared more ‘shady’ if I should use the term than their white counterparts. To account for that the researchers used a threshold test, which is a modification of a model, proposed by Gary Becker an economist for studying racial bias in policing in the 1950s. This model used the interplay between search rates and positive search outcomes to infer a threshold for search used by officers. When this test was applied to the data it suggested that tens of thousands of searches of minority motorists would be avoided if traffic cops used the same standards for searching whites as they did for minorities. As can be seen in the graph below White search thresholds are definitely higher than Black and Hispanic search thresholds.


Screen Shot 2017-06-23 at 3.53.10 AM

There is always going to be a lot of debate on this issue because other studies done looking at racial bias in policing failed to find any bias. Overall though most people of color and some whites will tell you they do not need any fancy analysis to know that there is bias or discrimination involved in policing. The negative impact of these biases and discrimination can be very clearly seen in cases such as Philando Castile or Sandra Bland who ended up dead after such a stop. For a large majority of motorists though these stops may be just a nuisance. What however needs to be addressed is the fact that on account of ingrained or implicit bias our law enforcement machinery is being used as a tool for racial discrimination against minorities. This is something that has to be addressed by specifically by our justice system and the society at large.



  1. National Public Radio (NPR) (Producer).(2017).  The Culture Inside: Alix Spiegel [Audio Podcast]. Available from
  2. The Stanford Open Policing Project 2017, The results of our nationwide analysis of traffic stops and searches. Available from



Special Order No. 40; I heard of this policy on one of the podcasts that I listen to, and thought that was really smart thinking so I decided to look into its origins.  After reading about this I gained a lot of respect and admiration for the late Darryl F Gates, Los Angeles Police Chief 1978 – 1992.  While Chief Gates was also known for aggressive policing in LA, he was the one who in the interest of public safety and community collaboration with law enforcement enacted this very important policy for his police department.  This rule prohibited LA police officers from initiating contact with anyone for the sole purpose of learning their immigration status and ruled out arrests for violation of U.S. immigration law. Over the years this has been adopted in various forms by many other police departments across the country[i]

Today the Trump administration in its aggressive stance on illegal immigration is looking at this policy and making efforts to withhold federal law enforcement funding from cities and counties that have adopted this policy. There are currently more than 400 sanctuary cities in the US today and whilst the Trump administration’s efforts to force such jurisdictions especially big cities like Chicago, Los Angeles and San Francisco to change policies related to local policing and immigration may have little real impact on decades long policies that police departments believe keep their cities safe, the constant wrangling over such issues is not conducive to the health of both legal and illegal immigrants in this country.


Immigration-and-violent-and -nonviolent-in-US
Crimes statistics for immigrants in our correctional facilities – Source: The Sentencing Project

Current LA police Chief Charlie Beck said his department will follow its decades-old policy of keeping officers focused on local crimes, leaving federal violations such as entering the country illegally in the hands of immigration officials. He reported that since January 2017 there has been a 25% drop in sexual assault and 10% reduction domestic violence reports by Latino women. Some counselors involved in cases of domestic abuse involving Latino women reported that some complainants have withdrawn their cases.  These withdrawals are due to fears among these women that either they themselves or their abusers could be deported if they went forward with their cases[ii]. The economic benefits of tighter and aggressive immigrations statutes and its impact on public safety in this country has been seen by many individuals involved in these issues to be mostly negative[iii]. That may be why no other person than Darryl Gates a Los Angeles police chief renowned for aggressive policing was the one who proposed and instituted this policy. The one reason why this has been adopted by more than 400 cities and counties across the county is because it keeps our cities safe. Up until his death in 2010 Chief Darryl Gates supported this policy which has come under attack by several presidents and politicians in various municipalities. Special Order No.40 has not only survived close to 40 decades in its city of origin Los Angeles; it has actually been adopted by several cities and counties across the country. If tougher immigration enforcement breeds crime then I believe our law enforcement officials will no better.


Data from The Sentencing Project on immigration and crime

After 38 years Special Order No. 40 a policy enacted by a Los Angeles Police Chief who was accused of racism in several instances still survives today, more than 7 years after his death.  Today in America the seed that was planted by Darryl Gates and has flourished and spread far across the country is under attack by the Trump administration. Our president has promised to keep us safe and I would like to believe that he is sincere when he says he is for public safety. Any attempt at using reduction in federal law enforcement funding to force cities to change a policy that most police officers believe works to satisfy a small minority of his electorate is federal overreach and violates the 10th Amendment.

I would like to remind Mr. Trump that he did not win the popular vote he only won 46.1% of the popular vote and Hillary Clinton won 48.2%. A recent poll suggests that only 30% of republicans and 11% of democrats support tougher immigration enforcement[iv]. This suggests that all his executive order on illegal immigration is not supported by a majority of American voters and is mostly unpopular among local law enforcement. I would like to let our president know that we trust the decisions of our local municipalities on how best to keep us safe. I don’t believe Americans want our presidents to determine how our police departments keep us safe


[i]  Smith D, Los Angeles Times, Feb. 5th 2017, How LAPD’s Law-and-order chief revolutionized the way cops treated illegal immigration,


[ii] Michael Balsamo, The Independent, March 22 2017, Latino population in LA reporting fewer sex crimes over deportations fears;


[iii] Nazgol Ghandnoosh and Josh Rovner, The Sentencing Project, March 17th 2017, Immigration and Public Safety, Police Chiefs believe intensifying immigration law enforcement undermines public safety


[iv] Mark Hensch, The Hill March 17 2017, Poll: Most support path to legal status for illegal immigrants,




Operation Six-Pack

About three years ago I posted a photo of myself wearing my biking gear on facebook and was aghast with horror when one of my old classmates made a comment on the size of my belly. Well it is three years and that belly is still resisting all my efforts to crash it into a fatty grave. Prior to the time of its appearance my response to any comments on my ever increasing weight was “it is all muscle”.  Well that comment pushed me into facing reality; muscle does not usually give your a paunch. I have since declared war on this new addition to my physical profile.  Unfortunately the battles fought in this war appear to be getting harder and harder to win as the years go by. Currently I do not know if I should throw in the towel or change my strategy. I have logged many miles on my indoor and road bike that could easily carry me across the US but I am still carrying this unwanted burden.

On the boardwalk in Ocean City, Maryland, May 11th, 2013
On the boardwalk in Ocean City Maryland in May 2013 getting ready to start Ride for the Feast 2013

Whilst considering all this I know that even if I change my strategy I would still continue to ride because I love riding and also cannot afford to miss doing RIDE FOR THE FEAST to raise money for my favorite charity Moveable Feast. Since the year 2011, the second weekend in May has been a special time for me. My first ride was the most memorable because after riding 104 miles from Ocean City to Wye Mills on the Eastern Shore of Maryland my muscles went into perpetual spasm.  I was on the verge of giving up on the second day of the ride which was another 36 miles from Arnold in Anne Arundel County into Baltimore City, the victory lap. Fortunately after struggling for several hours my muscles finally relaxed and I had a very refreshing night in a sleeping bag in the Gym at Chesapeake College. Well that is how it all started and today after 6 such rides I am training again for my 7th Ride For the Feast.

My team
Training for Ride For the Feast 2017 with my team members near Annapolis

May is my ride for the feast month and I do the ride on the second week. I usually celebrate my birthday a week or so later. I must confess though that by far my best celebration is ride for the feast and not my birthday.  The one reason why I enjoy this ride so much is that I get to do something that I love doing whilst helping people who are less fortunate that I am. Moveable Feasts, the mission that organizes ride for the feast has been providing free home delivered meals for breast cancer and HIV patients for more than 25 years. In 2016 Moveable Feast prepared and delivered over 815,000 meals to more than 5,000 clients. Moveable Feast also provides a valuable medical transportation service, making sure clients get to vital medical appointments. Additionally, they have a Culinary Training Program, not only teaching students the fundamentals of working in a kitchen, but also important life skills they can utilize outside of the kitchen.

After more than 6 years supporting this charity, this year I am experiencing some donor fatigue and the fact that I have to raise money for my 30 year high school reunion in Cape Coast, Ghana means that my focus is split.  As if that is not enough my Medical school class which is officially the class of 1997 but graduated in 1998 on account of a University Faculty Strike in 1994 decided this was the best time for a home coming celebration. Well, when it does rain it pours so something had to give and unfortunately my Medical School Homecoming has fallen by the wayside. So overall 2017, is going to be a busy year for me.

Classrooms and Assembly Hall in Mfantsipim School
Classrooms and Assembly Hall in my Alma Matter, Mfantsipim School, Cape Coast, Ghana

To my medical school classmates, I want you to know that honoring the gracious and hardworking faculty that helped train us to be who we are today is just as important to me as all my other causes. When it comes to making this choice I had to pick where I could make the most impact and poor Maryland patients and high school students in one of Ghana’s oldest school won the battle.   Readers and friends I cannot ask for you to assist me with my growing paunch or pot belly as we call it in Ghana but I ask that you assist me with a generous donation to the cause you want to assist me with.  With your help I can focus on my personal battle with my fatty parasite and hopefully get my 6 pack back.


To donate to Moveable Feast please follow the link below.

Follow the link to donate to my moveable feast ride

To donate to my Mfantsipim School 1987 Year Group follow this link

Follow the to donate to Mfantsipim School Old Boys Association 1987 group



Prevention saves lives – Meningitis in a resource constrained setting -by Dr. Teddy Totimeh – A physician in Accra, Ghana

Four students have died. One after the other over a ten day period. And the diagnosis is only certain now, after they died. In a country with 5000 doctors, multiple teaching hospitals, a Ministry of Health, and a Health Service, this is not acceptable. Especially if the country has had 60 years to build a system. It is not right. If there was a war going on, it would be excusable. If there was famine, civil unrest, natural disaster… maybe, this would be easy to ignore. Not in this Ghana. Not at this time.

On the other hand, considering that there are 2 newly built, multimillion dollar, appropriately commissioned centers of excellence in the same city waiting for medical staff to start working in them months after completion; and that there are 3 hundred physicians newly trained, who have been sitting at home for six months unemployed. There are municipal hospitals in regional capitals run almost completely by physician assistants… it is not surprising, that 4 students will die, in rapid succession, and we have no idea why.

And in 2017, we are able to yield our intellects to rumors of spiritual deaths, and panicked desertions of schools, distributing potentially infected patients, unscreened, into the wider society without prophylaxis. In 2017, we still have no way of anticipating the meningitis season, and vaccinating the vulnerable populations in the endemic areas, and educating them so that if students in crowded dormitories in these areas present at the hospital with fever and chills, there is someone there prepared to make the diagnosis and administer treatment.

And we have a media, with reporters, repeating the theories debunked decades ago, about heat causing meningitis. We have communication departments in the Ministry of Health, Ghana Health Service, Ghana Education Service and there is not a single public service announcement on meningitis. And four students have died already! We have a media blitz on galamsey (illegal gold mining) and our impending water deprivation, and not a single poster on meningitis in the meningitis season, so that whoever first saw those four could have resisted the urge to dismiss the students as malaria infected. It was BBC which broadcasted the tens of deaths in nearby Nigeria, just weeks ago. It was BBC which informed listeners about a new strain, that had become more virulent in this epidemic. We have media that monitor the global news. We have strategists who follow the infectious disease trends. And not even the multiple deaths in the country next door, could alert us.

Four students have died of a preventable disease. And no one will resign, no one will take responsibility, not the headmaster, not the nurses at the sick bay, not the physicians who missed the diagnosis, not the governmental agencies who did not inform. No one will step up and say why this should not happen in a civilized country, and why it should not happen again because something can be done about it.

Four students have died. And this week the students have come back to the school in their numbers for academic reasons… some exam coming up. And someone in leadership at the school is on radio, and acting surprised that the students actually turned up. And I have not heard anything about the screening that is supposed to have started as the students started turning up, or the vaccines that are being arranged to be transported to the locality, or the strain of bacteria that has been isolated, and if it is the same as killed scores in nearby Nigeria.

And 4 students have died already.


Posting from Teddy Totimeh a colleague working in Accra, Ghana

Let’s talk to our elderly patients about their sex lives.

He was referred to me by a colleague with a large geriatric practice for evaluation and treatment for HIV. He was 76 years old and lived in an assisted living facility. He was, however, very independent and only required limited assistance. When asked what he expected from the visit he responded that he had been sent to me by his PCP. Review of his records suggested that in addition to HIV and hypertension which was well controlled he also had some kidney disease. After reviewing his labs from his PCP, I informed him that his kidneys were OK, not great but for a 76-year-old gentleman, his degree of kidney disease was not too concerning. He did mention that he had been on medications for HIV for a few years, but this was stopped about five years ago for some reason he did not remember. Review of his records also suggested he had advance directives signed and he did not want to be resuscitated should he have a cardiac arrest. To put things in simple language, this 76-year-old gentleman had clear written instructions that stipulated: Should his heart stop beating or even go into an abnormal rhythm that could lead to his death, he would like to be allowed to die without any interference from health care professionals.

Overall, I was impressed with the foresight of this 76-year-old man, I however had to come back to the reason for his visit. He had been sent to me because he had HIV, my colleague could competently take care of all his other medical issues. During the visit, I asked my patient what he wanted me to do with respect to HIV, and he was non-committal. He mentioned that he had been off his medications for five years and was doing fine without any problems. To this, I informed him that his most recent CD4 count (which was a good marker of the health of his immune system) was about 260 suggesting that he was very close to developing AIDS if he was not restarted on ART. To cut a long story short after much discussion I managed to start him on a ART regimen. Over time, he became my oldest living HIV patient, and he did well clinically for several years. After I had left the practice, he was inherited by a colleague. About six months ago, almost six years after our first meeting, I met his PCP who informed me that he had passed away at the ripe old age of 83.

Today in the United States, HIV is now a disease not only of the young but is also affecting our senior citizens. In 2014, 17 percent of all new HIV diagnosis was among those aged 50 years and above and more than 1 in 4 of all individuals living with HIV today are above age 50 yrs. But controlling HIV transmission in the aging population comes with its challenges, one of these being our natural bashfulness in discussing sexuality especially when dealing with individuals older than ourselves. Most of our seniors are experiencing both widowhood and divorce and are beginning to date and develop new relationships. Health care professionals need to be more attuned to the day to day needs of their patients to provide them with the health care that is appropriate for them. Opportunities to screen appropriately for sexually transmitted diseases in our older populations will be missed if we assume they are too old for sex.

The market abounds with different types of sexual enhancement preparations including the FDA approved ones, so assuming older individuals are not sexually active is just not facing reality. Our bashfulness and lack of comfort with discussing sexuality with our older patients is not based on fact. Older patients are the most comfortable and forthcoming when discussing their sex lives or lack thereof. All providers, especially primary care providers, must include an appropriate sexual history in their evaluation. From my experience, sexually active older individuals have better overall health and a good sexual history may provide us with a better idea the cardiac health of our patients. We may learn a lot more from a good sexual history than we would get from ordering a pharmacologic stress test from some of our patients. So once again, I say let us talk to our older patients about their sex lives.


Leonard Sowah MBChB, MPH, FACP

Continue reading “Let’s talk to our elderly patients about their sex lives.”

My brother’s keeper – Healthcare in Trump’s America


I recently heard a story from a colleague about a patient that he admitted who refused admission for a potentially fatal illness because he was afraid he will be arrested and deported.  This incident happened during the Obama presidency that happened to have deported close to 3 million immigrants during the 8 years in office.  ICE (Immigration and Citizenship Enforcement) reports suggest that the exact number deported in the Obama era was 2,749,706; an average of 343,713 immigrants per year.  The Department of Homeland Security however still restricts enforcement from so called sensitive locations such as schools, places of worship, hospitals, and public demonstrations and rallies to allow undocumented immigrants easy access to those sites and services.  The problem that we face today with immigration policy is not the policy itself but the publicity associated with the enforcements.  As a physician I am focused on addressing the healthcare needs of all my patients irrespective of their immigration status. Unfortunately most undocumented migrants do not know and cannot be expected to trust us if they begin to feel that the whole nation is out to get

It is clear that the publicity related to the enforcement of our current administrations immigration policy can be harmful and may have unintended consequences on the health of our immigrants.  The current public nature of this policies is not all the fault of the Trump administration though.  The public nature of current enforcement is a relic of the election era utterances and pronouncement which continues to this day. A recent Pew Research survey suggest that numbers of undocumented immigrants in the United States has stabilized and as at 2014 a large majority (66%) of these immigrant are long term immigrants who have been in the United States for 10 years or more[i].  These are people with very strong social and economic ties to the United States and removing them from this country could have a significant economic impact on this country.  The health needs of these undocumented migrants unfortunately are the responsibility of the US government.  This may sound like a damning statement to some individuals but if you consider healthcare in its totality with the inclusion of communicable diseases we realize that creating an environment that makes our visitors as I would call them from now on unwanted can have a significant impact on the health of all Americans.

Our current leadership may have come into power with strong support from some evangelical Christian groups. Franklin Graham the son of Billy Graham in his speech at the inauguration of President Trump is reported to have said that Trump won the election by the hand of God[ii]. There is no way that anyone can challenge that because Franklin Graham most probably is basing his pronouncement on a personal message that he received from God.  I however have a very public message from the Bible Matthew 25 vrs 34 – 40 34 “Then the King will say to those on his right, ‘Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world. 35 For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, 36 I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.’ 37 “Then the righteous will answer him, ‘Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? 38 When did we see you a stranger and invite you in, or needing clothes and clothe you? 39 When did we see you sick or in prison and go to visit you?’ 40 “The King will reply, ‘Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.’(The Bible New International Version).


This is what the bible says; unfortunately the man chosen by the hand of God if I should believe Franklin Graham is singing a totally different tune.  I guess I can only blame God for all the fear and hatred that we see and hear about nowadays.

I certainly do not have the ear of President Trump so I do not believe what I have to say on these issues matters at all. I am just a lowly doctor and teacher trying to ensure that my patients believe they have unfettered access to my services and the services that other healthcare providers provide. These people that we call illegal immigrants are our neighbors, friends, uncles, aunties, brothers, sisters and co-workers. They pick the grapes and tomatoes that we eat. They clean our yards and sometimes they actually help build some of the information systems gadgets that enables us go to cities and towns we have never visit yet freely navigate these places.

Today, in America we hear about our visitors getting shot just because they did not look or act American enough[iii]. In this environment nobody can feel safe because we can never guess what the stranger on the street thinks of us.  This is America a country of immigrants and nobody should be made to feel unsafe or unwanted just by virtue of how they look, talk or act. My message to everyone especially to some Trump supporters who believe the United States is for only whites is; “ Please remember we are all immigrants the only difference is a matter of time”   We all need to feel safe and secure in this land and some of the xenophobic rhetoric must be toned down to ensure the safety of all of us living in this country citizens and visitors.


[i] Pew Research Center; 5 facts about illegal immigration in the US; accessed 3/1/2017

[ii] Religious News Service; Inauguration speaker Franklin Graham: God allowed Donald Trump to win; accessed 3/1/2017

[iii] CNN; Deadly Kansas Shooting: a senseless crime and a friend lost; accessed 3/1/2017

Difficult conversations – Talking about sex with your doctor

I recently read a book by Dr. Barbara Natterson-Horowitz a UCLA cardiologist who also happens to be a consultant for the Los Angeles Zoo. In her book ‘Zoobiquity’ Dr. Natterson-Horowitz demystified the story of HIV (Human Immunodeficiency Virus) transmission from monkeys in West and Central Africa to humans. Most doctors today including me have a very limited knowledge of zoonosis the science surrounding bugs that can be passed from animals to humans and can be totally unaware of the extent to which we share pathogens with our animal neighbors.

After reading about rabbit syphilis, Chlamydia in Koalas in Australia which almost threatened to totally wipe out these small cuddly creatures, and Trichomoniasis in T. rex, I could say nothing but agree that SIV (Simian Immunodeficiency Virus) from the chimpanzees to humans was not that fantastic a tale after all. Of course if Trichomonas has moved through the different species from as far back as the time of the dinosaurs to now infect both pigs and cats what stops SIV a close viral relative of HIV from expanding its real estate empire to include humans. We humans are after all are the most dominant specie on earth and as such we are a very attractive real estate acquisition for any bug.

Today HIV is a worldwide pandemic affecting almost every community in the world but it is believed that prior to its journey to the western world the virus had affected various communities in West and Central Africa for several decades. HIV-1 the commonest HIV subtype in the US and many western countries is believed to have entered the United States by way of Haiti. This is based on molecular genetics which shows close to 99% similarities between the gene sequences of viruses from Haitian patients compared to US patients. In the early days of the epidemic HIV had been known to be associated with the 4 Hs, Homosexuals, Hemophiliacs, Heroin Addicts, and Haitians. Unfortunately on account of the stigma associated with HIV, my Haitian colleagues did not look too pleased when I mentioned this on a recent visit to Haiti as a visiting faculty.

Today more than 30 yrs after I read the Newsweek headline on AIDS in 1986 which featured Rock Hudson’s declaration that he was gay and had AIDS the stigma still persists. In this era of good life sustaining treatment though, the terror and fear that made most people treat individuals known to be HIV positive like lepers has abated. The stigma still persists and in many cases makes efforts at prevention very difficult. This is a stigma that I can understand based on how society addresses sexuality.

Sexuality is humanities biggest double standard; whilst most of us are sexually active getting a sexually transmitted disease is considered a social taboo. Somewhere between our birth and early adulthood we somehow conveniently forgot that if sex really was so nasty we will be extinct as a race.

To adequately address this issue we should all start working hard on our skills in talking about sex clearly and effectively with our sexual partners and doctors. From my experience most doctors do not mind talking about sex with their patients but may still harbor some misconceptions that may sometimes make it difficult for them to start the conversation. More often than not doctors are trying to gauge patient’s comfort level instead of just realigning themselves and their patients and diving into the conversation. If a patient starts that conversation though most physicians are always happy to talk to their patients about this most important aspect of their lives. Conversations about sexuality and sexual issues if done well will open doors to preventing STDs (Sexually Transmitted Diseases) and HIV. Doctors can only know how best to treat a patient if they are aware of the sexual practices of their patients. Whilst most medical procedures are standardized there are modifications that are made to accommodate individual differences in patient characteristics and behaviors.

Currently even though there is a pill that can reduce risk of HIV infection rates by more than 90% in appropriate individuals most doctors fail to use or even think about this medication in appropriate patients. One important reason for this low utilization is because the sex conversation rarely ever happens to any meaningful extent. We cannot allow stigma and societal taboos around sexuality to get in the way of our health. If we think that HIV and other sexually transmitted diseases are dirty diseases then we are all dirty anyway. So let us get it out all in the open especially when it comes to our conversations with our doctors. “A word to the wise is enough”.