Category Archives: Health

Chasing Cholera in Haiti

This post was originally published on Medium.com on Mar 29, 2013.The deadliest river in Haiti

It was February 25, 2012, and I was tracing cholera’s path around Haiti, trying to understand how a disease so treatable could kill so many people. A cholera outbreak could never happen in Miami, all the experts said, but I didn’t understand how a bacterium could discriminate against who it would infect and kill, and why it was picking Haiti of all places to do this.

Silver bursts of sunlight caught my eye at irregular intervals as we wound around the bends of the Artibonite River on our way from Saint-Marc to Mirebalais. At 320 km long, the Artibonite is the longest river in Haiti. It provides the 1.2 million residents of Haiti’s capital city, Port-au-Prince, with hydroelectric power, making it the most powerful river in Haiti. And ever since the Nepalese faction of the United Nation’s military operation infected the river with cholera by improperly disposing of their infected waste, it has been the deadliest river in Haiti.

Artibonite River Dam, Haiti, Arikia Millikan

Whenever Americans hear that UN peacekeepers brought cholera to Haiti for the first time, they’re skeptical. But we know that’s where it came from because the Vibrio cholerae bacteria responsible for the outbreak has a genetic fingerprint, just like we all have fingerprints that distinguish us as individuals, and that particular strain came from Nepal. That’s where the troops were from who were stationed at the UN base directly upstream from the location of the first documented cholera case in Mirebalais.

Since the first case of cholera was documented in October of 2010, the disease has killed over 8,000 people and infected 649,000 others — over 5% of the population. When I was in Haiti in the spring of 2011, there had already been 4,672 cholera deaths. Health organizations were circulating information about the disease in hopes that simple awareness would curb it. Cartoon figures on concrete fences smiled patronizingly at pedestrians walking along rubble-littered streets, explaining how to properly wash one’s hands. There were rumors of advice whispered amongst the bourgeois: “Don’t eat the salad at such-and-such place, someone got sick because they washed the lettuce with contaminated water.” “Stay away from seafood, because, you know.”

Cholera PSA Haiti

In Port-au-Prince, there is no public water system — no infrastructure of pipes connecting residences to a main supply. But there is access to treated water, if you can afford it. Drinking water comes in jugs like the kind you’ve probably seen in offices attached to a conical paper cup dispenser. You drink it, rinse dishes with it, and use it to brush your teeth. Sometimes when you’re walking or driving around outside, you hear the high-pitched mechanical tunes that in developed countries signals an ice cream truck is near. In Haiti, it means the water truck is near. Little kids and adults alike chase after the truck, pay a few cents and receive a clear plastic baggie of water they carefully break open with their teeth or poke straws into to hydrate.

The Water Truck Haiti

There’s a different kind of water for bathing. It’s treated with bacteria-killing chemicals in a much cruder way. Some people have reservoirs underground to store it, and pumps to circulate it through pipes and out of faucets — if there happens to be electricity. Electricity from the main grid comes and goes in an unpredictable fashion. Forget about heated water. Without electricity, the pumps can’t circulate the water, which means bucket showers. You never, ever want to drink this water. The eyeballed methods of chlorination are unreliable. Too little and the reservoir is subject to microorganisms, too much and the chlorine leaves your skin with an itchy burn after your freezing bucket shower.

Many of the victims of cholera, I later learned, were too poor to afford these luxuries.

The car pressed on around the river, tracing the spread of disease from the first documented case, to the site of the first massive outbreak. Along the way, we passed several banners reprimanding the UN for bringing cholera to Haiti.

With me was Paul Clammer, the British documentarian who wrote all the major guidebooks to Haiti in the past decade. Our driver, Edzer, was a former member of the Haitian police force who had retired to go back to school to be a social worker. To earn money, he translated for journalists and helped them get around in Haiti. His laid back smile made him seem like a big teddy bear, but when a street vendor popped out of nowhere next to the car startling us all, his reflexes in hitting the lock button told me he was a teddy bear who could kill someone in two seconds if he had a reason.

We were driving along the path that Jon Lascher, the Haiti Program Manager for Partners In Health, had directed us to take to meet him at the new teaching hospital in Mirebalais. He had just taken us on a tour of the hospital in Saint-Marc that had once been filled far past capacity with cholera victims, their bodies all violently expelling fluid in attempt to rid themselves of the toxin-releasing bacteria that rapidly replicates in the low acid environment of the small intestine. The Vibrio cholerae bacterium doesn’t kill people directly — its goal is merely to exit the body and spread to new hosts. When people die from cholera, they actually die from dehydration.

A Cholera triage center

This is the ironic tragedy of the disease. Nobody should ever die from cholera because the solution is so simple: rehydrate. The miracle treatment that patients get when they go to the hospital for treatment for a cholera infection, is something called “Ringer Lactate”. It is essentially salt water. A standard package costs about $1.50. But for most people in Haiti, this luxury is simply unavailable.

As we drove, Jon texted me that there would be some scenic views of the Artibonite river as we got closer to Mirebalais, and asked where we were. I texted back that we had passed a town called Verettes 15 minutes ago. There were no stores or other landmarks along the way, just houses here and there — floorless concrete walls painted in cheery pastels with various plant life thatched over top to protect against the harsh sun and relentless downpours of the rainy seasons.

The rainy seasons, peaking in May and October, are when the cholera cases spike. Just when the epidemiologists grow hopeful that all the efforts of the public health workers have finally managed to quell the outbreak, turbulent storms rip across the country, mixing infected water sources with clean ones and enabling cholera’s transport far and wide, all over again.

I was staring out the window, looking at that treacherous river and thinking about all this and how horrible it would be to die that way, when I started noticing people walking along the side of the road, carrying massive loads of things atop their heads as Haitians do. I wondered how long it would take them to get where they were going, since we’d been driving a long time through a whole lot of nowhere. I noticed some of them were carrying big jugs of water, and I felt so bad for them because water is so heavy and they had to carry it so far since there were no stores for at least 15 miles.

“Edzer, where do you think they’re getting that water from?” I asked.

“I don’t know,” he said after thinking about it for a minute. “I hope not the river.”

“No, they know that river is contaminated,” I said. “We have to find out.”

Edzer pulled the car over and we all got out and started walking in the direction the people were moving. We caught up with a young woman and Edzer introduced himself and asked her where everyone carrying water was coming from. “La Source,” said the woman, who said her name was Michou Felix. We didn’t understand. She pointed down into the brush beyond the road. We asked if she could show us, and she shrugged and agreed. We walked down the street for a few minutes until she pointed out a break in the brush. She led the way along the path, down far away from the road into a shady grotto. It started to get muddy, and we passed an opportunistic wild pig basking near a puddle. Nearby, a chicken pecked the ground.

“La Source,” Michou announced with a wave of her hand. Paul and Edzer and I all looked at each other with different forms of surprise. In front of us was a twisted bunch of exposed tree roots out of which a natural spring was trickling fresh water into a puddle far more shallow than your average kiddie pool. A man was standing on a root off to the side, patiently holding a plastic container below the trickle to fill it up while his three kids played off to the side. He had another plastic container with blue liquid in it.

“Is this their drinking water?” I asked Edzer to have him translate. It was, indeed, the sole source of drinking water for the surrounding community, where people mostly worked farming sweet potatoes, bananas and peas. Michou estimated this measly spring supplied the water needs of 5,000 people. She said some people treat it with “detergent,” the blue liquid the man was holding containing anyone’s guess about what cocktail of chemicals it contained.

“Aren’t they worried about cholera?” I asked. Edzer took a deep breath and translated. Michou shrugged the most helpless shrug anyone has ever shrugged in the history of the world, and responded in Kreyol. Edzer turned to me and said, “This is what we got to drink. It’s the life we have.”

“But, what are they going to do when the rainy season comes? What if the river contamination seeps into their spring?” I asked. He didn’t turn back to her, but instead leaned in closer to me. “They live under the fate of God,” he said. “If you kept asking them about it, they would say, they live under the fate of God.” We thanked Michou and gave her some money, then headed back to the car. It finally all made sense. That was real Haiti. That was how most people outside the city lived, with their most important resource transformed into a roulette wheel of excruciating death and disease. When cholera struck communities like that, seeping into their drinking water reservoirs then crawling from family to family as people tried in vain to treat their sick, there were no simple rehydration mechanisms. The public health task at hand, to make clean water and sanitation systems accessible by communities like Michou’s, would take decades, if it could ever be completed at all.

As we walked back to the car along the road, I was blinded by the irony of the situation where on one side of the road was a massive river, overflowing with the most precious commodity on the island, but to drink from it likely meant death. Meanwhile, the all-but-hidden spring on the other side of the road was trickling groundwater at a rate that the average American wouldn’t have the patience to fill a bathtub with, and was supporting a community of 5,000 people.

A cholera outbreak could never have spread in Miami, the experts all said. I now understood why.

The Tidal Pool Treasures of Thailand

There is a place in Thailand that, to me, is the most magical place on Earth. I found it by accident, but I think I’d like to die there someday. I won’t say where it is, but if you ever want to go, tell me and if you’ve been kind to me over the years I will hand-draw you a map. In the mean while, I think we could all use a little magic during these tough times, so I’ll show you what I found there.

It all began when I woke up in my cliff-side bungalow the morning after I arrived, and looked out the window. By the first light of dawn, I saw something interesting outside:

tidepools1

It looked like the entrance to a cave off in the distance. I’d stayed here once before but this was a new bungalow—two years ago the jungle was covering this particular view and I didn’t know the cave existed.

While eating  breakfast I chatted with an adventurous Slovakian couple. After finishing, the man hopped over a low rail partitioning off the dining area from the rocky cliff, and waved goodbye. I turned to his partner, and asked where he was going. She pointed to the rocks below. I was amazed they were going down there, because not once had the idea occurred to me last time I was there. I assumed it was too dangerous and stuck to the several sandy beaches, each offering its own slice of nature that was more than fulfilling for me. Minutes later, she finished her yogurt and prepared to walk down to find her mate. Knowing nothing about them I thought perhaps they were the rock-climbing type, and asked about the decent. “Yeah the path is kind of treacherous but it’s worth it,” she said, climbing down in flip flops.

Surely if she was wearing flip flops, I could do it in sneakers. But she wasn’t lying about it being treacherous. When I climbed down later there was barely a path through the jungle overgrowth, and I crabwalked and bouldered down most of the way. When I finally reached the bottom though, it was magnificent peaceful rocky heaven.

OLYMPUS DIGITAL CAMERA

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100 days not smoking

It’s true! I was going to reward myself with something, but I can’t think of anything I want. Everything about manufacturing pretty much disgusts me these days. I think I have reached the end of Capitalism. All I want now is to write, travel, and eventually to come back and get a companion parrot. I guess I’ll just calculate how much money I would have spent on cigarettes and put it in a parrot fund or something.

Since you’re definitely wondering what kind of parrot I would get, I’ll tell you the options:

1) African Gray

parrot-africangrayThey are the smartest of the bunch from a human perspective. They require a lot of attention and can get quite sassy if they are displeased. But their ability to communicate astounds me and I would love to be able to be able to provide an engaging environment for one of these creatures that require so much intellectual stimulation. Most famously, Alex the African Gray demonstrated that parrots aren’t just mimics, and that they think critically to use words in context and apply referential meaning to objects just like humans do. Anyone who’s ever had a parrot knows they do that, but Alex scientifically validated it. And he could do fucking math. He didn’t get nearly as much YouTube fame as he should have in his short life, so I’ll be sure to teach my parrot to do math and make him a YouTube celeb in memory of Alex.

2) Amazon

parrot-amazonThere are lots of variations of Amazons. This one is a yellow-crested Amazon, and it looks exactly like the parrot that first enchanted me in Puerto Rico when I was 8 or so. There was one in a cage in a hotel near where I was playing at the beach, and I went over to look at it. It looked at me, and I don’t think I left the cage for an hour. One of the hotel workers came over to say, “watch out kid, that parrot will take your finger off,” and kind of teased it by flicking the cage. I knew the parrot just didn’t like that particular worker and that he really wanted me to scratch his neck. So I did, and the workers were amazed to find that an animal they assumed was aggressive by nature actually just had standards.

Amazons have a pretty big capacity for human language as well. I used to parrot-sit for an Amazon named Jake when I was in college. Jake’s owner had rescued him from a man who had no idea what he was getting into with parrot ownership, and grew so worn of Jake’s noisy demands that he kept him locked in a dark closet with only sunflower seeds (not at all the kind of balanced diet any kind of parrot needs) for years. Jake was too traumatized to be handled in his new home, but he still delighted in interaction. One time late at night, I got quite a startle to hear a man’s low voice in the house and thought someone was breaking in. Then I realized it was just Jake imitating his previous owner’s voice.

3) Eclectus

parrot-eclectus

Eclectus are just the most beautiful birds in the world, I think. They are a sexually dimorphic species, meaning the males and females look different. Above is a female, and the males are bright green with a candy corn beak. I once knew an eclectus female named Girdy, also a rescue that I parrot-sat. She had also lost trust of humans due to a traumatic past, but she really tried and it was cute. She would sit on her stand and when I would try to pick her up she would have a neurotic breakdown, part of her wanting to step up and be a carefree parrot again, but the abused part of her holding her back. Her eyes would turn frantic and she would start panting a little bit. I succeeded in picking her up a few times, but felt bad stressing her out by the process, so I decided to just admire her from afar.

Someone once asked me why I liked parrots so much. It’s because parrots only care about three things: play time, snack time, and mischief. What better companion animal is there than that? Don’t get me wrong, I love all animals, but parrots are just the best.

My ideal future parrot is one I would raise from an egg, like I did my childhood parrot. That way you become their BFF automatically. The ethical thing to do though would be to adopt a parrot, since there are so many adult parrots out there in need of good homes. Chances are an adopted parrot probably wouldn’t be as nice as one I raised, or have the learning aptitude and vocabulary, but as long as it would let me scratch it’s neck every now and then, I would be happy.

The first mention of “vagina” in a film

…was by Disney!

From Oddee:

As strange as it may seem, Walt Disney was on the forefront of women talking about their vaginae (plural of vagina). In 1946, Disney was commissioned by the Cello-Cotton company (who made Kotex feminine napkins) to make a film called The Story of Menstruation, which mentioned the V-word for the very first time on celluloid. The film was never released theatrically, but was shown to 105 million American students, along with advertisements for girls to make sure to use their brand when it came to “that time of the month.” The film was hardly pornographic – in fact, menstrual blood is shown as white instead of red. It is now in the public domain and can be watched below!

It’s actually pretty awesome, but pretty sad to notice how not far sex ed has come since the 40s. My kids will have 3D hologram diagrams of ovaries if I have anything to say about it.

Via Ira Cashewnutskya

The I Ching For Dummies

I was over at my Belarusian friend’s apartment after doing yoga, drinking kale smoothies and talking about self-improvement, and we started talking about our childhoods. I told her some of the highlights of mine, about my fractured relationship with my mom, and she looked at me and said: “You say that Americans complain a lot even though they don’t have real problems, but I don’t know what’s worse — living next to Chernobyl or growing up like that.”

ichingSo she started telling me about the I Ching, AKA the Book of Changes, a text based on ancient Chinese teaching which I guess is the equivalent of the bible in terms of how people study it and use it to guide their lives, though it has nothing to with a god. She said that perhaps it could help my mom shed some of her negativity if she read it. I told her I didn’t think she would be receptive to anything that wasn’t Tea Party propaganda, but she brought it out and started flipping through it to show me. It was thicker than the DSM and had so many lessons in it that you were supposed to roll dice to determine which lesson you would read daily. I don’t know what kind of face I made when I saw it but she’s very perceptive, so she went and retrieved a much smaller book. She handed it to me with a smirk and said in her thick Eastern European accent, “Ok how about this? This is like the I Ching for dummies version.” Now we were talking. I flipped it over and read the back of it:

Universal laws govern everything. Several of the laws form a path that leads to the achievement of goals. In every case, those who follow the path to the end achieve their goals, overcome their fears and get what they want. Most importantly, they discover who they are in relationship to the Universe. The perceive a brand new Universe – a treasure chest. Whatever you do now, whatever you now believe, whatever your current circumstance may be, you are perfectly equipped and fully capable of fulfilling your needs and desires. You can have what you want. This book will direct you along the path and create within you a new self image.

I told her I was still skeptical that my mom could be helped by anything or anyone, but she told me to take it and read it myself because maybe it would help me. I opened it and felt better after reading the author Wu Wei’s comment before the book even started: “Because you are reading this, be aware that the Universe, in its complete awareness, has brought you together with what you need. It means you are ready.” So when I packed my bag to go into the city that night, I opted for the I Ching over the The Bell Jar.

I’ve never, ever been religious. I dismissed the idea of Santa flat out as soon as I heard the notion that he was watching me all the time, along with the other supernatural entities. I’ve also never considered myself “spiritual”. To me this word was associated with those southern baptist churches where the people pretend to have seizures because the “spirit” is inside of them and hallelujah and what not. After a few pages of this book though, I finally realized what all the new-agey hipsters in Brooklyn meant when they talked about “The Path” aka “The Path to Spiritual Enlightenment”. Upon this realization, I supposed I was alright with being “on it”.

Not to get too existential about all of this, but reflecting about this in terms of authoritarian symbolism where God is a mentally contained father figure, it’s not surprising I didn’t take well to monotheistic religion with all of its baked-in paternalism, not having a father and all. Now being 26 and considering this Taoist idea of the Universe being an all-seeing, all-knowing entity that produces us and constantly surrounds us, comforting us and steering our destiny for our personal benefit if we are obedient to the teachings of the human sentinels that deliver its messages — it kind of feels like how I would imagine it feels when loving parents hug you.

It’s always been logic and rationalism and reason in my mind, and ultimately, solitude. I’ve always been sort of jealous of people who can delude themselves into thinking that some supreme being is watching over them, taking care of them and making their decisions for them about how to live. But I’ve always said I’d rather be uncomfortable than deluded. Is it delusional to think that the universe cares about me? The author of this I Ching reader basically admits that it is, and says things like “think about a task you failed to complete in the past and imagine yourself completing it. Then imagine yourself completing it and think about it again, knowing you completed it. Even though you didn’t, if you tell yourself you did enough you’ll have peace of mind.” Is delusion the path to happiness, and if so can it be learned? Should it be?

Ok ok, so I’m on-board with making peace with the past. But here’s the thing that will take some serious concentration. This book tries to teach you to not be phased by upsetting things by telling yourself that everything is perfect because you’re here now, on this path leading you to better things despite the seemingly unpleasant things that happened in the past, because it couldn’t have happened any other way. This was the universe’s plan for you all along, so why get upset when bad things happen in the future, because the universe has your back like it always has?

I see what they’re doing here. I get it. It’s unproductive to be mad and dwell on fucked up things because it will only make things cascade into worseness. But like, the guy playing some stupid Zynga game at full volume next to me in the coffee shop today while I was trying to work? I suppose Wu Wei would look at him and think he was perfect! He’d probably thank him and then thank the universe for putting him on the stool right next to him. My first thought? “Excuse me, but I’m trying to follow the path to spiritual enlightenment here and you’re in my fucking way, so please move.”

Am I doing this right?

Not yet, but hugs from the universe feel nice so I guess I’ll keep trying.

Content

Contentedness is not a feeling I know well. Typically when I’m happy, I get scared wondering when it will end. But I’m just pretty content now that I’m feeling healthier than ever. My yogi, Ira, believes all ailments come from a lack of love. I have been very sick for the last 10 years, propagated by the fact that I’m a pro at acting like I’m ok when I’m not. I’m strong, but I have my limits. If there’s one thing that reiki is good for, it’s acknowledging that the sick should not treat the healthy — they have to recover before you can level up and heal others.

I’ve been thinking about this metaphor lately, which I kind of hate because it involves a Disney movie. But there’s this scene in The Little Mermaid where Ariel is heading down into Ursula’s lair to sign her voice away in an act of dumb sacrificial romance or whatever. She swims over Ursula’s garden where there’s all these things that look like seaweed but are really just shriveled up mer-people:

ursulasgardenAs Ariel swims over, they kind of extend out to her. At one point I think one tries to grab her fin and she shakes it off with this spooked expression. And that’s kind of what it’s like sometimes in New York. It’s not like Ariel doesn’t want to help all the “poor unfortunate souls,” it just takes her a while to understand how they came to be that way, why they can’t be blamed for their condition, and how to help them. The plan ultimately means swimming past them for the time being and coming back to help them later.

On helping yourself so you can help other people

The night I heard the news of the earthquake in Haiti in 2010, I did what I used to do to cope with stress — dissociate using any kind of chemical I could find. I went to the store and bought a pack of cigarettes after not smoking for two months, and went to my local bar where I proceeded to get wasted. I always liked going to this bar alone because on any given day it was inevitable that some interesting person would come along and strike up a conversation.

That particular night I found myself seated next to a man from Sierra Leone. After a few martinis, I wound up confiding in him that I felt like the scum of the universe that night because an earthquake had just struck Haiti, the bodies were piling up, it was possible that my family there was hurt or worse, and all I could do was sit in the comfort of my life in New York, in this bar, and worry about it. I told him I wanted to be on a plane there doing something to help, but instead I was sitting there not helping anyone, especially not myself.

He sort of chuckled and in a very wise old man way (even though he was only 25) took me to look here: he was from fucking Sierra Leone. Most of the people there live in poverty, there are civil wars and violence all the time and people generally live in fear. It wasn’t until the Blood Diamond came out that most people in the US even heard of the place, which is an indication of how little foreign intervention they get there. He told me wants to do so much to help his family and friends there all time, but he was sitting right with me and not feeling guilty about it at all. Why? “Because that’s all anyone wants, is the ability to because to just sit somewhere and not have to worry about anything in that moment. It’s all my family wanted for me,” he said. And then he told me something for the first time that I would hear many times over the next few years, which is that you have to help yourself first if you want to have any hope of helping other people.

I struggled with this concept at first because on the one hand it sounds like rationalization for laziness and selfishness. But when it comes down to it, it’s just accurate at a very basic level. That’s not to say that you can’t always be helping people. I help people when I can and love doing so. But in the past few years I have found myself overextending. I tend to attract people who try to take advantage of my compassion, who perhaps haven’t quite figured out how to sever the parental ties and look for mothers and fathers in other people. They look for it in me because they see me as independent, someone who “has her shit together,” and they cling for dear life hoping I can help them be the same way. And I want to, and part of the reason I work so hard is so that someday I will be able to, but sometimes I just can’t. But I’m terrible at saying no to people when they ask for help, so sometimes I try and try and it drains all my energy from my very core, and I turn into this listless shell who can’t even walk to the corner store let alone address an international crisis. I am independent and I probably do have my shit together more than the average 26-year-old living in New York City, but I am that way because I have to be. I don’t have a safety net like so many of my peers, so when I fall, it really hurts. I can’t afford to fall anymore.

So don’t worry if you hear me going on about raw food and meditation. I’m not joining a hippie cult or something, although the yoga studio across the street could pass for one. I really just want to try everything that crosses my path to be healthy, so I help other people in the biggest way possible while I’m still able, and I’m really grateful for the people who are able to help me do that right now.

New Health Regime

Tomorrow will mark the 50th day since I quit smoking. I am virtually withdrawal symptom free now, although I still secretly love second-hand smoke. One of my friends suggested that I reward myself on cessation milestones and buy myself something with the money I would have spent on cigarettes, so I am buying a flute! I found a nice silver-plated used one on Craigslist and am picking it up tomorrow. I’m super stoked, I used to love playing the flute when I was in 5th and 6th grade and won a few competitions playing Mozart, but quit because I had a mean teacher. Getting back into it seemed  thing where I’d always be playing catch-up, so I never picked it back up. Furthermore, an activity that requires blowing for extended periods of time is not that feasible for a smoker.

Go ahead with the flute jokes.

Anyway, that’s just phase one of my new health kick. The second phase involves joining my favorite Belarusian refugee’s sticker club where we set daily goals in a spreadsheet and get stickers if we meet them. On Friday she asked me to edit her scholarship essay to knock the “Russian propaganda vibe” out of it and make it sound more colloquially American, and after reading about what a productive and disciplined life she leads I was amazed! I asked her if she thought being in a daily goals club could work for me, and she invited me to join. My goals include waking up at 9, morning papers, eating breakfast, meditation, eating one raw meal a day, doing yoga or cardio 4 times a week, blogging, and not bringing my phone/laptop/tablet into bed because it disrupts my sleep.

It’s funny how rudimentary this all seems, but I’ve realized recently that I really do need to start from square 1 when it comes to learning how to take care of myself. I’ve been skirting by on coffee, cigarettes, take-out, drunkorexia, and cheap thrills, so it’s really no wonder I get stressed out sometimes. My self-discipline is pretty abysmal, and I’m skeptical that I can stick to this regimen. But if anything is going to teach me discipline, it’s an Eastern European health guru.