Saturday, June 02, 2018

The Wedding Speech

Dalai's Note: My daughter "Dolly" got married last week to an incredible guy whom we'll call "Lama". Forgive the awkwardness of these false names in the following piece, but I did want to share my "Father of the Bride" speech with everyone. If you were wondering, this might have something to do with my lack of posting lately...

If I could have your attention for just a few moments…

I want to welcome all of you, our good friends, old and new, and family, old and new, to this celebration for Dolly and Lama! We are thrilled to have you here on this wonderful occasion! I can’t begin to tell you what it means to all of us that you have joined us here in the Rainy North! It’s nice to see that we have about as many doctors as lawyers! I promise to try hard not to make this sound like a closing argument, but maybe more short and sweet, like my Radiology reports: Normal, but clinical correlation required!

I really want to thank everyone who worked so hard to make this amazing evening possible. First of all, thank you Lama for asking Dolly to marry you, and thank you, Dolly, for agreeing! Obviously, there are quite a few moving pieces to an occasion like this, and Mrs. Dalai and Dolly, with help from our wedding planner, have done a great job of pulling it all together. We might not live up to the standards of that British wedding last week, you know, the one with Harry and Meghan, but I promise we’re going to have an equally good time.

A marriage unites two people, but it also unites two families. I think Mrs. Dalai and Dalai, Jr., and I are almost as happy as Dolly is about her new husband (I’ve got to get used to saying that!) and her new extended family. We, of course, were not part of the selection process, but I hope we would have done as well! Back in the old days, such decisions were made on the basis of who had the largest tracts of land...we’ve come a long way since then!

We knew Lama was a special guy from the moment we met him. In fact, on that first meeting, Dolly had been burning the candle at both ends and in the middle, for something new and different, (I think she had been on call the night before) and she managed to fall asleep in her chair over drinks. Of course, it doesn’t take too many drinks to knock her out anyway, but I’m sure Lama knows that by now. So, the three of us ignored her, and talked for several more hours, and we had a great time! That Dolly was relaxed enough around Lama to doze off and leave us to interrogate--I mean talk with him, well, that spoke volumes. By the way, Lama, you passed the interrogation with flying colors.

A couple should complement each other, and Dolly and Lama certainly do. Both of them are multi-faceted, and they each bring a huge list of talents and interests to the relationship. Dolly and Lama bike, sail and ski together and have introduced to each other to many more activities. Here’s one you might not know about her, Lama: Dolly as a child liked to roller-blade, but she had trouble with stopping when skating down the hill of our driveway, so she usually ended up diving into the bushes at the end of the run. Hopefully she doesn’t do that on the ski slopes!

While Dolly and Lama do have many common interests, they differ in many ways, like their chosen professions. The combination of a physician and an engineer is a bit unusual. I wear both hats, so I understand to some degree the traits and characteristics that have to coexist. Lama, as an engineer, has demonstrated an analytic approach to things, as well as common sense, at every turn, at least since we’ve had the pleasure of knowing him. Dolly, on the other hand, is an example of why we should be careful about what we wish for. Before Dolly was born, Mrs. Dalai prayed for Dolly to have her nose and my brains. Unfortunately, Mrs. Dalai forgot about my lack of common sense when she made that wish! I’m proud to say that Dolly is a fabulous physician, and has strong and caring instincts when it comes to her patients, but as for common sense, well.... Lama, it will be nice to finally have someone in the family who really does have that very uncommon quality. And good luck, by the way.

This wouldn’t be a proper Father of the Bride speech without me revealing an embarrassing Dolly story, so I’ll use my favorite to illustrate the common sense thing. Dolly, was named after her grandmother and her great-grandfather, but she has been known by a dozen nicknames over the years: Pookie, Big D, Spark Plug, Artzy Dolly, Sissy (courtesy of Dalai, Jr.) and probably some camp names we don’t know about. And when her mom and I needed to talk about her when she was in earshot, we referred to some little girl named Yllod, Dolly spelled backwards. I’m not sure when she caught on to that one, or if she ever did! Yes, Dolly, that was you we were talking about!

At the end of her Senior year of High School, she was out and about with her friends, on her way to help with the Senior Prank. This was to be nothing really bad, just filling the halls of her school with balloons. But the police were quite vigilant that night, and while no one was arrested, Dolly did get to have a nice little chat with one of the officers. Now, here’s the punch line: When they asked her name, Dolly, not using whatever common sense she was graced with, quite helpfully answered, “Do you want my real name or the name I go by?” Hopefully we have that problem solved as of tonight. You may know Dolly wasn’t sure what name to use after getting married. Since she has publications in the medical literature, her first thought was to still be “Dr. Dolly Dalai”. But ultimately, she decided to take Lama's name, and so she is now Dr. Dolly Lama. That has a nice ring to it, doesn’t it?

Along with the new name will come a new dimension in Dolly and Lama's relationship. Those who know me well are quite aware of my warped sense of humor, so forgive me when I declare that it goes without saying, or at least it should, that the marriage is much more important than the wedding. But the wedding is pretty important, too, and seeing the happiness in Dolly and Lama's eyes tonight is certainly the crowning joy of parenthood.

And so I lift my glass and ask you all to join me in wishing Dolly and Lama a lifetime of happiness and laughter, of joy and harmony. Listen carefully to each other, don’t take yourselves too seriously, but do take each other seriously. May you cherish each other, treasure your time together, and may the excitement of this evening continue throughout your lives together.

And with that I’ll say, Cheers!!! L’Chayim!

Sunday, April 01, 2018

Driving "Miss Taxi"

As my second trip to Ghana winds down, I think of what I've seen and accomplished. The people I've met, the places I've visited. The mark I've left on this wonderful nation, and that it's left on me. One returns from a trip like this a better person, and that growth is enhanced by those who touch your life during the brief sojourn away from the known.

I have literally met royalty this trip (long story, won't talk about it for privacy reasons.) I've worked and played with some very fine physicians, IT people (yes they are!), technologists, and and so forth. Neither an abundance nor a lack of resources can dictate the someone's quality (or lack thereof). Suffice it to say, there are good, kind, capable, and amazing people anywhere and everywhere. You just have to find them.

I'm going to tell you about the most amazing person in Ghana, perhaps in Africa, and maybe beyond that. Her name is Esenam Nyador, but she is known throughout Ghana as "Miss Taxi". And she is KNOWN throughout Ghana. Everywhere we went, she was recognized and greeted as the celebrity she truly is.

My fellow volunteer discovered Esenam in the process of figuring out what to do over the weekends, when there is little activity at the hospitals. Any Google search involving "Ghana" and "guide" will yield listing after listing mentioning "Miss Taxi". And so, we had a tour like I've not experienced anywhere in the world, planned, executed, and delivered by someone who is very clearly proud of her nation. Her love for Ghana shines through at every point, and it is very, very infectious.

I could give you a travelogue, and drone on with descriptions of stop after stop. But I'm not going to do that this time. I'm not even going to put up more pictures. You need to come here and see this place for yourself, and you need to have Esenam show it to you. Trust me. I'm a doctor.

So what's the big deal with "Miss Taxi" you ask? It's all there in her nickname. Miss. Because Esenam has almost single-handedly broken into a formerly (and still, to a considerable degree) all-male field.

The odds were truly against her. Esenam was a single mother of two boys when she decided she was not going to let the world keep her down. Scraping by to make ends meet, she went to college, getting her first degree (Social Work major, Psychology minor...her SECOND degree is a Master's in Family Resource Management) from the beautiful University of Ghana. (I know it's beautiful because Esenam drove us through the campus, and we were able to see it through her eyes.) Having a rather strong entrepreneurial spirit, not to mention just a touch of rebelliousness and maybe just a bit of feminism, she chose the taxi business "because this is is a very non-traditional thing to do for a woman in Ghana, and I think of my decision as a gender statement. I didn’t mind stepping on a few toes to change the status quo."

In the United States, we might shrug and wonder why this is a problem, but in Ghana, it's a problem. A BIG problem. The male Taxi Unions would not let her participate in the business. Until, that is, she offered to take the riders they wouldn't transport. And from there, she built a thriving business.

People still stare, four years into this social experiment, if you will, at the "lady taxi driver". While there are a few more, this is still a male-dominated business. But there are clients, perhaps mainly female, who feel safer with a female driver. And many of those women have husbands. See how it goes?

Esenam has been featured on Ghanaian television, and has received worldwide praise and notoriety. She has TWO big ongoing projects, one that trains women to drive buses, and the other, trucks.  In fact, she's just back from Germany, where she received a rather important award. I'll let her tell you about that and her two ongoing projects:

The project that I work on is known as Women Moving The City Project. It seeks to training 60 women to drive intra-city commuter buses in Accra. The training is gradually grinding to its end and our ladies are awaiting the official agency to test them and grant them driving licences. The project is been funded largely by GIZ Ghana, Scania West Africa and West Africa Transport Academy. I actually started out as a volunteer for the project, right from the project campaign design stage as the ambassador. Months into the project, GIZ Ghana hired me as the Gender Consultant on contract and they are extending my contract till August to cater for the second project. It humbling to know that my volunteerism to help empower fellow women has not gone unnoticed! The project won a third position prize in the GIZ Global Gender Projects award in Germany on the 9th of March this year.

The second project has just been rolled out. It's dubed Women Moving Trucks. It's equally funded by the same team. Twenty women are to be trained for a logistics company for ready employment to transport goods on the western corridors of Ghana.

I could go on.

Kids, I'm not a feminist. I'm not a chauvinist. My daughter, Dr. Dolly, says I'm a humanist. If that translates to simply not caring about trivial differences, I'll accept the title. But seriously. I have always had a few innate beliefs, and Number One on my list is that everybody is equal, and should have the opportunities afforded to anyone else. I've just always felt that way. Can't tell you where I got it. Everyone has strength and nobility, and so on, and we need to celebrate that, and we need to let everyone on the planet evolve to their full potential. Keeping someone from doing so because of their gender or skin color or whatever is just plain stupid. I can't drive a truck or a bus, and I wouldn't last 39 seconds driving a car on the streets of Accra. But I have zero problem working with someone who DOES have those capabilities. Female? Why do I care? Get me there safely and comfortably please. Which is exactly what Miss Taxi does. 

Ghana is a poor nation, but its people are the most gracious I've met in a lifetime of world travel. Their hospitality is second only to their generosity. All they want in return is to know that they have pleased you. What they might lack in material wealth, the Ghanaians make up for with their honesty, and humility. And Esenam is the epitome of Ghanian grace.

Come to Ghana, to Accra. And let Miss Taxi show you the sights. You won't be sorry. Unless you ride with someone else!

April's Fool

Good morning. Happy Easter, and Happy Passover, and Happy Whatever to those to whom the first two don't apply.

Having been hard at work in Ghana the past two weeks, and trying to get back onto Eastern Time this weekend, for the first time in the history of, there will not be an April Fool's Day post.

Sorry to disappoint. I know you wait for this with great anticipation every year, but I'm going to have to let you down. In the meantime, try Google's version.

Rest assured, next year's edition will be YUUUUGGGEEE!


Wednesday, March 21, 2018

I Bless The Rains Down In Africa...Again

Some of you might have noticed that I haven't posted for a while. Did you call? Did you write? Did you check to see if i was still alive?

Sorry...just the Jewish mother in me coming out. I'm sure you all knew that the hiatus was justified, and you simply decided that my next missive would be well worth the wait. And I certainly hope to rise to your expectations.

Many things have indeed been happening. Doctor Dolly is getting married in a few months, and you can imagine the turmoil joy that has brought to the Dalai household. In the midst of plans for that amazing(ly expensive) event (JUST KIDDING, DOLLY!!) I received a promotion to the Management team of RAD-AID, which has taken up a great deal of time. Fortunately, this came with a tripling of my salary from my favorite NGO...I went from $0 to $0, but the satisfaction derived from being a part of this is priceless.

And yes, I've been back in Ghana for the past week on another RAD-AID trip to Korle Bu Teaching Hospital in Accra. As I noted upon last year's expedition to Dar es Salaam, Tanzania, you just can't be in Africa without thinking of Toto's song by the same name, and I must again present both the original and a very moving chorale version:

OK, time for business.

I have been delivering lectures to staff, residents, and anyone else we can gather. I managed to hit the ground running in that regard with an introductory talk about Nuclear Medicine to the Internal Medicine Department. Which occurred at 8AM sharp the day after I arrived in Accra (at 8PM but who's counting...) Despite some computer glitches (when connected to the projector, my borrowed laptop tried to go into Picture in Picture mode or something like that), the talk seemed to be well-received and there were many good questions asked.

We were able to meet with some of the radiologists and with Dr. Awo, the Nuclear Medicine physician:

My main duty here at Korle Bu, beyond boring the staff with Nuclear Medicine lectures, is to help pave the way for a RIS to mate with the PACS. There will be many discussions in that regard as we progress, but the principals here are pleased with the way we are approaching this project.

I have been able to travel a bit, seeing Accra last Saturday and going back to Cape Coast Castle and the Kakum Canopy walk on Sunday. I'm not going to post all 300+ pics, but here are a few highlights. I have to note that wherever we went, little children tagged after me, and usually not the ladies. I'm thinking they saw the old white guy with the white beard and figured I was Santa Claus. Ho, Ho Ho! Christmas in March in Ghana! Except it turns out that there is no Santa tradition here. Oh, well....

I've got another week to go, with a trip to Kumasi and a surprise!

I should note that I don't speak even the slightest bit of Twi, the more common of over 70 dialects in this region...I tried last time, and after getting laughed at, I decided to stick to English. It IS the official language of Ghana, after all!

But for now, I bid you Maadwo, a very good evening!

Sunday, February 25, 2018

Life REALLY Imitates Art!
More on Apple's EMR

To welcome myself back after a two-month absence, I'll brag a bit about my prescience. You'll recall my April Fool's Day mock-up of an Apple EMR:

No, it wasn't real, for those who didn't realize this.

But as with "The Simpsons" predicting an unlikely candidate (some say this isn't true, but go with it),

Apple has finally come around. I alluded to this in a recent post, but it seems to be coming to pass quickly. Here's the latest, from Wired of all places...

IN LATE JANUARY, Apple previewed an iOS feature that would allow consumers to access their electronic health records on their phones. Skeptics said the move was a decade too late given a similar (and failed) effort from Google. Optimists argued that Apple was capable of translating health data into something meaningful for consumers.

But the announcement portends great things for consumers and the app developers seeking to serve them, from our perspectives as the former US chief technology officer under President Obama, and as an early adopter of the Apple service as Rush University Medical Center’s chief information officer. That’s because Apple has committed to an open API for health care records—specifically, the Argonaut Project specification of the HL7 Fast Health Interoperability Resources—so your doctor or hospital can participate with little extra effort.

This move is a game-changer for three reasons: It affirms there is one common path to open up electronic health records data for developers so they can focus on delighting consumers rather than chasing records. It encourages other platform companies to build on that path, rather than pursue proprietary systems. And it ensures that the pace of progress will accelerate as healthcare delivery systems respond to the aggregate demand of potentially millions of iPhone users around the world.

Understanding the promise of this announcement requires a bit of historical context. In the wake of the 2008 economic crisis, President Obama signed into law the Recovery and Reinvestment Act, which included more than $37 billion for investing in the adoption and use of electronic health records by doctors and hospitals. Tucked away in that program was a comparably modest $15 million investment in research and development to bring to life a vision of applications inspired by Apple’s App Store. That R&D funding contributed to the development of the open API standard that Apple now requires of providers wishing to make the feature available to their patients.

Spurred by financial incentives in the Recovery Act, the Affordable Care Act and in 2015, the bipartisan Medicare Access and CHIP Reauthorization Act, providers are implementing health IT systems that are certified to meet certain government requirements.

One such mandate is to allow patients the ability to connect any application of their choice, like Apple Health, to a portion of their records via an API. However, the government left room for the private sector to build consensus on how to achieve this requirement, which resulted in the Argonaut Project specification. Apple's decision to require that open API standard decreases the likelihood that health IT developers will adopt a proprietary system.

Better still, once a provider’s electronic health records system delivers health data in accordance with the standard, that same connection will be available to any app developer offering consumer applications, including those built for the Android ecosystem, or competing to serve the highly anticipated Amazon, JPMorgan Chase, and Berkshire Hathaway employee health joint venture. Imagine if Apple had instead introduced a proprietary system that didn't allow competitors to access data in the same manner from the participating providers.

Naysayers point out the fact that Apple is currently displaying only a sliver of a consumer’s entire electronic health record. That is true, but it's largely on account of the limited information available via the open API standard. As with all standards efforts, the FHIR API will add more content, like scheduling slots and clinical notes, over time. Some of that work will be motivated by proposed federal government voluntary framework to expand the types of data that must be shared over time by certified systems, as noted in this draft approach out for public comment.

Imagine if Apple further opens up Apple Health so it no longer serves as the destination, but a conduit for a patient's longitudinal health record to a growing marketplace of applications that can help guide consumers through decisions to better manage their health.

Thankfully, the consumer data-sharing movement—placing the longitudinal health record in the hands of the patient and the applications they trust—is taking hold, albeit quietly. In just the past few weeks, a number of health systems that were initially slow to turn on the required APIs suddenly found the motivation to meet Apple's requirement.

When we look back a decade from now to render judgment, it will be the impact Apple Health has had in changing the default setting in health information sharing—from closed to open.

Two points. First, I knew there had to be something about Obama Care that wasn't all bad. This is it. Second, don't count Google out.

Still, Apple is the master of usable GUI's, and IF they continue down this path, they will be come a major player in this space.

Told you so.