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Editor's note: This is the second installment of Colville physician Dr. Barry Bacon's travelogue/report from the African continent and his ongoing work there.
Editor's note: This is the second installment of Colville physician Dr. Barry Bacon's travelogue/report from the African continent and his ongoing work there.
One of my jobs here is to find stuff that doesn't work and see if I can make it work. Mostly things on the car: a door that needs adjusting, a choke that needs reattaching, a glove compartment that flops open, a seat that won't adjust. In the house there are a few items as well---a toilet that won't flush, an oven door that won't close, a washing machine that isn't hooked up, a water heater that doesn't work. The young physicians I work with all laughed when I told them I brought a pipe wrench and a hammer, among other things. They wondered what that was all about. I told them the story of the trip across South Africa, Zimbabwe, and Mozambique to Malawi when we had a fire in the engine compartment with nothing to put it out except a serving of tomato juice, and two blown shocks. Since the accelerator cable had burned up, I had to rig a hanger through the firewall connecting the carburetor linkage to the hanger wire. I could pull on the other end of the hanger and rev the engine. I drove for 100 miles like this until we reached a spot where the "refurbished" ambulance could be fixed. I had forgotten my tools. I didn't want that to happen again. Once my colleagues began to see that a few things around the place were being fixed, they were happy for the tools.
Since we have fixed a few things at home and in the car, we heard about a list at the hospital that needs help. Jeff left a list for me with one thing in particular that was close to his heart. The oxygen concentrator isn't working. That is our project for today. I plug it in and it sounds fine. But try as I might, I can't get any oxygen out of it. I decide to tear into this project. Perhaps it is something easy, a hose that has come unhooked or has a crack in it. I pull the machine apart into pieces. I pull off the vacuum hose. No problem with suction. I pull off the outflow tracts. NO problem there. I trace the hoses around the serpentine routes through the machine to their various destinations. Everything is hooked up. I pull off one of the end hoses. I blow into the end. It is completely plugged up. I chase it down a bit more. I am embarrassed to say it, but the end of the connection is plugged up with mud. The fix is as easy as taking a needle and running it through the orifice. I place the connector back on and turn on the machine. It runs like a charm.
I call the nursing supervisor. I am delighted to tell him that the machine works fine, and that it can be used immediately. He is ecstatic. He explains that the machine has been sitting in a back storage room for a year, since it stopped working. I pull off the end connector and explain how it can be checked and fixed if this happens again. I smile at myself that the solution was so simple, but my method of finding it was so convoluted. On the other hand, I wonder how many more years the machine would have sat in the back closet losing its useful life and wasting the resources of whoever donated it to the patients of Sagam. I wonder how many other pieces of equipment we will uncover in our investigation of the hospital.
The Maasai people were so moved that they decided to give the people of the United States a gift.
Maasai Gift
Paula told us a story about the Maasai that I thought was worth repeating. Paula is a young internal medicine physician who practices hospitalist work in New York City. She has been accepted for the fellowship program here at Sagam, but will still work part time in New York.
There was a Kenyan living in New York City during the Sept. 11, 2001 terrorist attack on the World Trade Center. He returned to his home shortly afterward and had the opportunity to tell the story to a group of Maasai people who lived near his home. As he explained the loss of lives, the destruction of the buildings, people leaping to their deaths, the Maasai people were so moved that they decided to give the people of the United States a gift. They wanted to give something from their very heart. They decided to give the people of the United States of America a gift of ten cows.
In order to understand the significance of this gift, you have to understand the Maasai worldview. The Maasai believe in one creator God. They call Him Enkai. Enkai's favorite animal is the cow. He has entrusted all of the cows in the world to the Maasai, His chosen people. The Maasai believe that all of the cows in the world belong to them, since God gave them to the Maasai people. So their gift of ten cows was something of deep significance to them.
The U.S. ambassador to Kenya was told of the gift of the Maasai. He went to visit with them and to accept the gift. The ambassador explained how grateful the people of the United States were to receive this gift, and how much it meant that the Maasai people had sacrificed for them. However, he explained, America could not accept the gift because it was too far away and the way was too difficult.
On the other hand, would it be possible to sell the cows and take the money to buy beads? If the Maasai women were willing, they could make some of their beautiful beadwork. This would be brought to America and displayed at the memorial to Sept. 11. Then all of the Americans could come and see the compassion the Maasai felt for those who suffered and could enjoy the beauty of the gift they had made. The Maasai agreed.
So it is that when the Memorial to Sept. 11 is opened in New York City, you can see the beautiful beadwork the Maasai women have made to comfort the people of the United States. You have heard of the gift of the Magi. Now you have heard of the gift of the Maasai.
Oct. 14
Our weekend plans have taken a bit of a left hand turn. We had the incredibly great idea of traveling from Kenya through Uganda to Rwanda to pick up my motorcycle and bring it back. I would then leave it here in Kenya as a backup vehicle for emergencies. Things got messy.
We didn't know about the need for the original logbook for a vehicle crossing into Uganda. So we had to spend some extra time at the border promising to come back, check with the officials personally on the way back, pay a fine, buy some extra insurance, etc. Uganda is deceptively large. I knew this, but my friends had an idea of when we would be across Uganda, and it turned out that all of us were optimistic. We got to Kampala and traffic was at a standstill. After waiting for an hour without moving, the group decided that getting the motorcycle wasn't such a necessity after all. We would reconfigure our trip and head to Jinja instead.
Jinja is the headwaters for the Nile River, flowing out of Lake Victoria. It is a common tourist destination with quite a bit of outside money flowing into Uganda. The Nile is beautiful here, with a tremendous volume of water right from its beginning. Tourists often raft the Nile, bungee jump over the Nile, fly or parasail over the Nile, or kayak the Nile. We were going to raft the Nile.
The first rapids are a 10-foot waterfall. That's your introduction to rafting the Nile. The Nile is not as continuous an adventure as some of the other rivers I have been on, but except for the Amazon, it is definitely the largest volume of water I have been on. The rapids are spectacular, incredibly powerful, and being thrown into the Nile like a wet t-shirt into a washing machine (one of the rapids is called "the washing machine") and held under for a few seconds, only to come up and realize that the Nile River is residing in your trachea is definitely a memorable experience.
There is a tremendous variety of bird life along the Nile. Inexpensive places to stay if you don't mind a tent or camping experience. Some are very fine guides and some delight in dumping visitors into the water as often as possible. But some of the best memories are the ones you don't expect and couldn't have predicted.
The Flower
When we reached the river, we were divided into three groups. There were three groups of five, one group of four, and a smattering of ones and twos, 19 total. We had to divide ourselves into three boats, 6, 6, and 7 in each of the boats. The director decided that one of the larger groups needed to be split up in order to make it work, so he chose ours. Our group of five would be divided between the three boats. Godfrey and Luke would go into one boat with a group of four Americans from Minnesota; Paula would go with a group of British guys; wouldn't you know it, Jennifer and I would be stuck in the boat with a group of young women from Sweden, Austria and Germany. (OK, I've had worse fates.) The truth is, they were very focused young ladies, and they were a blast. For most this was their first rafting trip, but they did very well. Well, all except that one time when Maya, seeing the rapids coming up, ignored the guide's command to "paddle hard straight ahead". "Oh-oh", she said and dove into the bottom of the raft. We were thrown into the Nile more than once together, and floated down the river on our backs looking up at the fish eagles, hornbills and cormorants sunning themselves along the banks.
One of the girls in particular caught my eye. She was from Sweden and spoke the language well, but her olive brown skin color, black hair and solid body build looked more Mayan Native American than her Swedish friends. Jennifer asked about the meaning of the tattoo on her left shoulder. She explained that it was a reminder of her ancestral home in Chile. I had a chance to ask her a bit more of her story.
Joyce's family moved to Sweden when she was very young. They moved there, she explained, because they had family in Sweden already. She carried the stoic facial expression so common among Native Americans as she spoke. I asked if they had moved because of political unrest. Yes, she nodded. I stopped at that. Political refugee. I didn't want to pry further. Probably a lot of pain behind that story.
She mentions the children who, for Christmas, ask only for a chance to go to school.
We stopped for a lunch of biscuits, pineapple and juice on the banks above the Nile. I talked with Anika, the girl from Austria for a while over lunch. Her story was fascinating. She seemed eager to tell it to someone, anyone who would hear it and understand.
She has been in the country of Uganda for the past three months. Now her time is winding down. She has a couple of weeks to herself, so she and some friends are here rafting the Nile. She is having a great time, as I am, but she can't stop thinking about the experience she has had.
She is a social work student and is here on a bit of a whim. Her Mom didn't want her to come, thought it was too dangerous. (She hasn't written home about floating down the river in croc-infested waters yet.) She was plugged into the poorest, most destitute part of the slums surrounding the capital city of Kampala. She is a changed person.
She has made a lot of mistakes in her life, she confesses. But this experience, she can't forget it. She is so different now. Her attitudes toward the things that she has, the things she takes for granted, she sees that so many of the things we "need" in our materialistic culture aren't important.
She writes to her friends at home and they don't believe her. "No," they write back, "you are lying. Things can't be that bad." She mentions the children who, for Christmas, ask only for a chance to go to school.
"I can't help but think of all the things children back home ask for. Everyone needs to have an i-pod," she muses.
She describes a family of five who slept together in a space of about two meters by two meters. Yet they offered her a place to stay for the night. And the woman who knelt before her to thank her for the medicine she bought for her skin condition. It was a small amount of money, but unreachable for the woman. She didn't know how to thank Anika, so she knelt in front of her and tried to express what she felt.
Anika is overwhelmed at this point of the conversation. Her voice is choking and her eyes are tearing up. Her skin is visibly changing; the hairs on her arms are standing on edge. She is profoundly, physiologically moved by what she has experienced here. She came on a whim to further her education. But she was overwhelmed by joy, by compassion for these people.
"I told them last week that it was my last day with them," she chokes a bit as she speaks. "But the next day they still came looking for me. 'Where is Nachimuli?' they were asking. That's the name they gave me. It means 'a flower'." The flower of the Nile.
Beautiful things show up in the strangest places. This girl standing before me is nothing special. She is plain looking, straw colored hair, average height and weight, working on a social work degree. But at this moment, I see how beautiful she is becoming. She is being changed from the inside.
I offer a few words of encouragement. I warn her of the difficulty of transitioning back to the West, where people want to talk about what you have experienced for, say, 30 seconds or so, and then they want to move to important concerns in the "real world" such as the latest theory on what Michael Jackson's doctor is doing now. I offer to correspond with her if she finds this frustration too much, or if she just wants to talk to someone who might understand. We talk for a bit longer. She doesn't want to stop just yet. I ask her to remember to carve out time in her life for the poor of this world. I urge her not to allow the busy-ness of life crowd out the people she has met. Give them a seat at her table, invite them into her life, put them on her budget and find a way to do what she can. It is a good life, I assure her, a life worth living.
We are off again, rampaging down the Nile River in a raft, rowing, leaning, laughing, falling in, choking, and screaming. I can't forget the flower that I met. I wonder to myself, what if life was more like that. Meeting people who are changed, moved by this world to live differently, a life of significance, and taking the opportunity to give them a nudge, encourage them, affirm them, give them value, reward them for making a different choice from the usual materialistic self gratifying culture of the world we live in. It reminds me of what a young preacher once said, "I was hungry, naked, thirsty, imprisoned, and you fed, clothed, quenched, visited me." It's the criteria for the judgment. It's what separates the righteous from the wicked. Nachimuli may not know it yet. She has discovered the secret to everlasting life.
CD4 Count of One
By all accounts, she shouldn't be alive. By my brief glance, she doesn't look like she is.
We are on rounds again at Siaya Hospital. We are looking over the devastation of the past week, patients with HIV, TB, diabetes, stroke, liver failure, meningitis, and malaria. We are trying to find out what happened to the child we attempted to resuscitate last week, but no one seems to know.
We are making rounds on the adult wards. The new attending physician just started today. He has been in Kenyatta Hospital recently. He is committed to excellence and sets a high standard for the 35 or so students that are trailing him today. He grills them on a number of topics and expects them to know their patients well. He won't tolerate sloppiness. I like this guy.
We finish in the male ward and move to the female ward. It is already afternoon. The attending physician is trying desperately in this first day with the students to impress them with the importance of taking their work seriously. By the looks on their faces, they are taking him seriously. He tells them they have until Friday to learn the whole of knowledge about tuberculosis and HIV. He adds to that malaria. Oh yes, and anemia. He wants to make physicians of them yet.
The study of medicine in Africa is never easy. Lack of equipment, limited resources, limited tools and overwhelmed systems, satisfaction with mediocrity and crummy attitudes can drive you crazy. This physician seems to be on a one-man crusade to change all that.
There is a woman sitting on the edge of her bed struggling for air, and we don't know why. There is a woman with diabetes and hypertension who has suffered a stroke, but we don't know if we should treat her or not because we don't have a ct scanner. There is the woman who came in with hemoglobin of 2.4 (normal is 12) who can't get blood because it is too expensive and there is no blood bank here and the blood must be obtained by family members from Kisumu 2 hours away and no one has taken the trouble to change the system to actually save lives. There is the woman with HIV sitting in the ward with a CD4 count of 1. 1. The doctor draws in a deep breath and looks at her. It's not compatible with life, but here she is. All 87 lbs of her. At first glance it is hard to tell whether or not there is anyone there. She is alone. We learn that everyone in her family has died from this disease. The group moves on.
CD4 count is a way of measuring what is left of the immune system, at least the part of the immune system that gets hammered by HIV. Normal CD4 counts hover around 800. Patients below 400 need special treatment. Those below 200 are at risk for a variety of dreadful diseases. Those below 100 need to be propped up with all kinds of medicines.
I don't know that I have ever seen a human with a CD4 count this low. As I stand at the back of the mob of students surrounding the attending physician who has found another hole in their knowledge and is trying to plug it, I can't help but steal a curious glance at this woman. I wonder at her life, what were her dreams, her goals, her plans to be a mother. I wonder what was lost with her lying here in a hospital bed. I look over at her. She is staring back at me, her eyes sunken, hollow, curious, questioning. No doubt she is wondering at my life as well. What am I doing here? What brings this strange white man to this hospital? Do I have a family? Is my life a good one? Do I love my wife, perhaps more than she was loved?
I smile at her. She manages a weak attempt in return. I walk slowly to her bedside and take her hand in mine. I don't speak her language, but I smile at her eyes. I take her x-rays and look them over. I sit beside her and feel her sunken face, peer into her eyes, her dry coated tongue, check her lymph nodes, listen to her lungs and her heart, check her abdomen, feel her enlarged liver and spleen, the doctor sort of thing. I'm trying to tell her something else. I am hoping that she senses through my hands what she cannot understand from my words. She watches me, curious, wondering, too polite to protest, perhaps grateful for human touch, if only by a physician. I grasp her hand again, and she squeezes mine with her thin leathery palm. I smile at her again, the kind of reassuring smile that a physician gives to his patient that says all will be well. But I think my eyes cannot lie to her. I fear that she sees the sadness that is there, that says I know I will not likely see you again. She cannot live long like this. She represents all of the wasted talent and motherhood and vibrancy of 25 million Africans who are on their way to the same place she is going, into nothingness. I want to wish her peace for her journey. I want to give her courage for the days ahead. I want her to travel into this unknown place with the sense that her life mattered, that she was loved, that she could rest without fear.
Fish Ponds
I wanted to see some fishponds, because one of the things the Pokot people have requested for their development project is to raise fish. Their water supply is so seasonal that the water runs through with a fury and then dries up. We have to find a way to slow the runoff and capture the water in ponds, then raise fish for sale and for personal use. This will give the people another stable source of protein in their diet.
We have tried for several days to connect with Dorothy, one of the hospital workers who have offered to show us to the fishponds near her house, just about 200 yards from the hospital. Every day we have to postpone the field trip due to rain or some other issue. Today, the rain was brief, so we are going. Just before leaving, the rest of the team sends a message. There is no water at the house and they need me to bring some. Also, could I bring Luke's lab results? Luke had fluid splash in his eyes while trying to care for a child in shock. He will be taking a drug regimen to prevent HIV transmission for a month. He feels sick from the medicine and had some labs done to make sure he is ok. From the looks of Luke, I can understand why people stop taking their medicine. We look at the treatment of HIV as miraculous and life saving, but the truth is it is wretched. You feel like a floppy, angry, depressed, arthritic egg noodle.
Godfrey and I accompany Dorothy down toward the fishponds. We walk down a small hill where she points out her water supply. It is gravity fed protected spring, water coming out of the ground through a perpetual pipe. The excess water runs down the hill into the ponds, about six in number, terraced into the hillside. We find a woman working beside the ponds. She is about 60 years old, friendly and helpful, but embarrassed at seeing a white person down by her ponds. She is cheerfully whacking at some sweet potatoes that grow along the side of her pond. I ask a few questions through Dorothy.
The woman seems happy enough to take a break from her sweet potato harvest. She explains that each pond, about 25 yards by 50 yards can hold 2000 fish. The fish crops are rotated about every three months so that harvesting takes place year round. These fish, catfish and tilapia, take about 6 months to mature. When ready to sell, the water is drained from one pond into the next, recycling the water. Pipes flow in and out of the pond so that water and flooding can be controlled. The shallow end of the pond is ankle deep. The deep end is 4.5 ft deep. Fish stir up the mud as we talk. She feeds the fish a mix of flour, dry grass and dry minnows, stuff that floats. Fish are prone to being eaten by birds, dogs, and the neighbors who sneak around at night, she continues. How much does she make at harvest. It depends, she explains, on how many fish are eaten by the dogs, birds, and neighbors. A heron flies overhead as we talk. Besides, she continues, there are widows and orphans who come. She can't charge market price to them. Can she give us an average? She thinks for a moment. About 1500 shillings, she estimates. $18 for three months work. I swallow. I'll have to rethink this fish thing. I want it to be a source of income for someone. It's a lot of work and a lot of vigilance.
We walk back up the hill. Dorothy has offered to let us borrow a couple of jerry cans for the water problem. We travel to her modest house a block away. We shimmy through a crooked heavy gate into her yard. Turns out she lives in a pasture. "Watch out for these cows," she warns, "they are wild." I look at the cows. Aside from the impressive horns, the scrawny beasts look pretty safe. We step gingerly to Dorothy's house, balance on the narrow walkway around the perimeter to her front door. Just inside, she has stored several buckets and jerry cans. Her laundry hangs just inside the front door. "You know, you have to watch these cows," she explains. "They like the taste of soapy water. If you leave your laundry out on the line, they will eat your clothes. You come back and you find your shirt is half gone."
We carry the buckets down to the spring by the fishponds and slowly fill them the African way, rinsing, washing, and shaking before filling them. We watch children nearby curiously looking at us. "You have to fight with the school children sometimes for water," Dorothy explains. She goes on to advise us about carrying water on our heads, jerry cans, and cows. These are the African way of life.
We purchase two jerry cans for Dorothy in exchange for the two she is giving us. We load up the water and drive back to her place. We help her get her buckets back inside the fence, and she is satisfied that she can take it from there. "I am safe now," she explains, "although these cows look thirsty. I have to watch them or they will get my water." I look over the fence. She is surrounded by a herd of big horned beasts, all staring at her. We thank her for her kindness and close the crooked gate behind us. "Otherwise these cows will get out," she shouts after us. I smile to myself. The hospital receptionist lives a simple African life in a humble cement home with a tin roof with her laundry hanging inside the front door to protect it from the cows that prowl outside hoping to drink soapy water drawn from a spring down the path that leads to the fish ponds tended by the friendly lady who chops sweet potatoes while watching for herons, dogs and neighbors in order to make $18 and still finds a way to help the widows and orphans who live nearby. I shake my head at the thought. It is the mystery and majesty and honor and frustration and generosity and poverty and loveliness of Africa. We bounce along the road home in our rickety Pajero with two jerry cans filled with spring water.
Find your life of usefulness, a life that is beyond belief…
One of my jobs here at Sagam Community Hospital is to look over the inventory of what we have available to us. We are doing this with the thought in mind that we want to move things in the direction to provide a higher level of care necessary to train family physicians. We are missing some pieces, both in equipment and in training.
I have been asked to begin in the operating theatre, or operating room. I pulled down some packs to review the contents. Looks like the last sterilization for some of the sets was ten years ago. The c/section pack is complete; that's good news. The #1 general set could be used for multiple purposes, including a backup for c/sections, hysterectomy, probably some abdominal cases. The #2 laparotomy set is missing a few pieces. It could use a couple of retractors and an operating scissors. The sets for dilation and curettage are fine, except they are missing the dilators and curettes. I scour around the operating room, but for the life of me, I can't find those vital pieces. I'll put them on my shopping list.
I peruse the various boxes lying around the room. Some look promising, some contain garbage. Some have never been opened since 1963. I pull out a couple of the packages. American Medical Instrument Company, Columbus GA. Date of packaging: January 1963. I realize that these instruments, deaver retractors and malleable retractors, are nearing their 50th birthday, having never found their usefulness.
I think I can make use of some of these instruments, so I opened a deaver retractor. It is carefully wrapped in plastic. Inside, the instrument has a tight foil wrapping. I open the foil and breathe in the scent of the 1960's factory in Georgia where it was packaged. The grease protection has long since turned to sticky molasses. I turn it over carefully, admiring its brilliance, shape, and I wonder at the person who painstakingly packaged this instrument. What was she like? Was she a mother? Working hard to support her family? Did she have dreams for this instrument? Did she hope that the hard work of the factory and her own hands would help to save someone's life? I determine that the 50th birthday of this instrument will not be spent like the last 49, sitting in a box in an obscure corner of a dusty operating room.
I grabbed some soap and water and scoured away the glued on grease covering. The stainless steel still shone like the day it was made. I smiled as I admired its design and grace. I dried the instrument and laid it carefully in the set alongside the babcocks, allises, metzenbaums, and kellies. At last it had found its place in the world, after only 50 years. I know that the factory worker who packed this deaver away all those years ago is likely long gone, but I'd like to think that I honored her memory in some way. If someone reading this happened to work at the American Medical Instrument Company in Columbus Georgia in 1963, I just want you to know, you did your job well. The instrument you wrapped so carefully looks gorgeous alongside all of its colleagues in the operating set at Sagam Community Hospital. At last, it has found its life.
Maybe this is a parable. No matter what the age, a life sitting on a shelf without purpose or direction can still find all of this and more. I just want to encourage you, pull off the wrapper, clean up the grease and find your life of usefulness, a life that is beyond belief.
Oct. 19
Sinaga A:
It's early Friday morning. The car died again last night, the latest in a string of near death experiences for the Pajero. This time the hydraulic clutch breathed its last. I called the mechanic early this morning and asked him to replace the hydraulic cylinder that pushes the clutch plates apart. Who knows how long that is going to take, since he will have to locate a similar piece from another Pajero? I am walking to the hospital to catch the ride to the "outreach clinic" at 7 a.m.
We climb into the "ambulance". It is a four-speed shift on the column minivan. It looks like someone ate the armrest on the driver's side. Bare metal spans part of the dashboard. A vent window is shattered. The sliding door is so dry from lack of lubrication that it has to be slammed with considerable force. The same door doesn't open from the outside, so someone has to open the window to open the door from the inside. The dear driver dutifully grinds the worn starter against the worn flywheel again and again. He stops when the starter doesn't engage and pumps the gas a few times hoping that will help. Finally the starter kicks in, and the engine roars to life.
We drive a couple of blocks and stop to pick up Dorothy, the one who lives in the pasture with the cows, and another lady, one of the community health workers. The two community health workers who accompany us today are of the traditional African build, kind, generous sized women whose job it is to communicate health to the villagers and organize them for health projects like todays. One of the women has a face so gentle, she reminds me of an African female Buddha.
We continue on for ½ mile until we reach a trail alongside the road and follow it down to a field. The community health worker directs the driver across the field to a home on the other side. A cow with a large hump is tied to the house. We bump around to the front of the house where two more cows watch us curiously from where they are tied. This is where we will hold clinic.
Our supplies for the day consist of containers of paracetamol (Tylenol), cough syrup, ibuprofen, and amoxicillin. Also a bp cuff, some paper, a notebook, and a large thermos of tea and five cups. The team sets up two tables and some chairs under the eaves of the house where we will be seeing patients.
Dorothy invites me to investigate the local guava trees.
"Here we have so many guavas," she begins to extol one of the many virtues of life in western Kenya. "You know, in Nairobi, these will cost 10 shillings! (About 12 cents) But here, they fall off the trees." She selects two from the tree. "This one is not good," she explains. She refers to a ripe one. "These are the best." She points to a green one. I ask how we should peel them. "You eat the whole thing," she replies.
I watch her as she takes a generous bite out of the green exterior. I wipe off the outside and try to navigate my mouth around the tough exterior. My lips are pretty well toast, having not recovered from the Nile expedition. I take a bite and notice that it tastes like, well, a really green, unripe thing. I glare at Dorothy. She doesn't notice. She is busy explaining that some guava trees are taller than others, some have better fruits, some ripen sooner, some she doesn't like. "I think they are different species," she muses. She turns to me. "What do these have?" she asks. Vitamin C, vitamin A, I reply thoughtfully. I keep chewing. And chewing. Also lots of fiber, I conclude. "Oh," she ponders the meaning of this. I carry the second guava to the workstation for later.
We begin with an elderly man wearing a Special Olympics t-shirt from Maryland. He has several issues he wishes to address today. A couple of kids are seen. Evan is a four year old with a fever. All of the children today have enlarged spleens, one of the common signs of chronic malaria. Many are pale, malnourished, distended bellies, cheerful, fun loving, curious. Evan spies my guava, and reaches out his hand. He looks up at me with guilty four-year-old eyes. I give it to him. He is delighted.
An elderly man with a Las Vegas shirt wants some help with his arthritis. An 87 year old with dark glasses and a fishing hat wants to know about his hernia. We explain that he needs surgery. He says he was told that if he had surgery, he would die. We explain that he could die if he doesn't have the surgery. He seems comforted by this news. A one year old has a respiratory infection. Several more have malaria. An elderly woman has hypertension and arthritis. A three-year-old boy has had a stroke, likely due to sickle cell disease. Two older women look like they have TB. Everyone is listening intently to each other's medical problems, HIPPA be hanged. Between patients, I watch malachite kingfishers, pied wagtails, mouse birds, an indescribable sky blue bird, brown kites flying, soaring nearby. The Buddha lady is lying on her stomach on the grass in the shade.
The hospital calls. They need the ambulance to pick up someone. "We are nearly done," replies the nurse who accompanies me. 45 patients for the morning. We head back just as a vehicle from the hospital comes looking for us. "They were going to take the ambulance and leave us stranded," explains Dorothy. Amazingly, the vehicle that came to get us is the Pajero. The mechanic found a replacement hydraulic cylinder and has it back on the road. We head back to the hospital with a handful of patients for admission. The empty medicine bottles bounce across the dashboard on the way. It's been a good start to the day.
Signs off the wall at Siaya Hospital
"Suture removal- 50 shillings (about 60 cents)
Admission- no charge"
At Sagam Hospital
"Sagam Community Hospital: We offer at reasonable cost: 1. Hearse 2. Coffins 3. Lowering gear 4. Tents."
To be continued…


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Friday, October 10, 2008 - 9:56 AM
Meinl Drum Festival: Jost Nickel Video
i got back from berlin last night via train. i really got a good load of work done during the train ride. so that was good :-) i may use the ICE more often now as i really enjoyed using it this time.
anyways, here comes a jost nickel drumsolo filmed at our festival. jost is an amazing guy. he has just started to get into workshops and the clinic-scene a little bit. glad he did, because he certainly has a lot to say on the drums. his playing is fabulous. it feels great, it grooves, it's got an unique musicality and character. some of the licks he plays have become kind of his trademark. for example his unique crash-muting technique starting in the video at about 6:47 minutes. jost is currently working on the new album for german singer jan delay. check out his latest release "mercedes dance live" for more of josts' great drumming.
the meinl festival has openend some new doors for jost, like the one to another drum-event in london in '09 possibly :-)
next week, we'll post some of johnny rabb's video footage. so stay tuned and have a great weekend!
3 responses to "Meinl Drum Festival: Jost Nickel Video"
Lerryns Hernández posted on Oct 13, 2008 - 17:44 PM
Thanks for this video Norbert.
I did not know the work of Jost and I\'m impressed with his feeling and groove...In the pocket!!!
Christoph Raucheis posted on Oct 13, 2008 - 21:44 PM
I thin everybody is waiting for a video from the drum duet...which was the best thing of the whole weekend.
when are you going to upload those?
norbert posted on Oct 15, 2008 - 12:01 PM
hi christoph,
we have made two drum-duett videos of benny and johnny. the first one is now online. the second one will follow a little bit later. enjoy
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The rebellious spirit of Matthew Maguire's first Labor Day is spreading again across our country. Join the parade!
It's a bit odd that in America's thoroughly corporatized culture we have no national day of honor for the Captains of Industry, and yet we do have one for working stiffs: Labor Day! Where did it come from?[read more]


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MGM Shirley Knight seems content with Paul Newman in this scene from the 1962 film "Sweet Bird of Youth," but she was startled by his suggestion that they go behind the set for some serious smooching to prepare for a love scene. "I must have turned 50 shades of red, I was so shocked and embarrassed," Knight said. It was a vintage practical joke from Newman, who did it in front of his wife, Joanne Woodward.
MGM Paul Newman and Shirley Knight in a scene from the 1962 film "Sweet Bird of Youth," based on the play from Tennessee Williams. Said Knight of Newman: "The people who are most revered are the ones not putting themselves in magazines. I don't think self-aggrandizement is very good, and he didn't do that at all."
MGM Shirley Knight played Paul Newman's hometown lover in the 1962 film "Sweet Bird of Youth" and earned her second Oscar nomination for the part. Knight will receive a lifetime achievement award at the 14th annual Ojai Film Festival this weekend.
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LEFT: Actress Shirley Knight in a photo from her early career. Knight is a two-time Oscar nominee and Tony-Emmy-Golden Globe winner and will receive a lifetime achievement award at the 14th annual Ojai Film Festival on Sunday morning, part of several events featuring her. Contributed Photo
20th Century Fox ABOVE: Shirley Knight (left, with Doris Roberts and Shirley Jones) developed quite a following of young people for her role in the 2006 film "Grandma's Boy." LEFT: Knight earned her first Oscar nomination for her performance in the film "The Dark at the Top of the Stairs."
Contributed Photo Actress Shirley Knight is in a lighter mood in this 1960s-era shot. Knight will be honored at the 14th annual Ojai Film Festival this weekend.
Senior Cinema Circle Shirley Knight plays a 75-year-old woman who embarks on an 80-mile adventure in "Redwood Highway." The 2013 film will screen Friday at the festival.
MGM Actress Shirley Knight, who will receive a lifetime achievement award at the Ojai Film Festival this weekend, has plied stage, film and TV over her long career. She said she's done her greatest work in the theater, saying of film and TV, "You don't get better at what you're doing. You don't go through the time it takes to develop a great character."


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Flights to Strasbourg from Europe
Flights from Strasbourg
Discover all the richness of the region through its history, its landscapes, its cities and villages. Immerse yourself in the culture by visiting potter's villages or typical villages like Obernai, Colmar, Kaysersberg…and crossing the famous Wine Route, one of the oldest in France and renowned worldwide. Finally, if you like nature, discover the Alsatian environment in the Vosges Mountains. This region is famous for its Regional Natural Park and its vast open spaces which offer a range of sporting activities such as walks and hikes, mountain bike, skiing…
Strasbourg, capital of Alsace and home to the European Parliament, is one of Europe's most attractive cities. His past is largely preserved. Every quarter and monument has its own identity and evokes the rich history of this city. The entire city center, called "Grande Ile" is listed at UNESCO World Heritage. Encircled by the "L'Ill", the center gathers the main places and monuments like the Cathedral, the Petite France, the Kammerzell house… Strasbourg attracts thousands of tourists who leave with wonderful memories.
There are a lot of manifestations in Strasbourg, but the most important is the Christmas market in Alsace. From the end of November to the end of December, a visit to Alsace is like a visit to a fairytale land! During this period, towns and villages are decorated with thousands of lights and hundreds Christmas markets take place throughout the region. On this occasion, discover Strasbourg, capital of Christmas, and its famous Christkindelsmärik, the oldest Christmas market in Europe. Come into this wonderful world enhanced by the magic of Christmas.
The pink sandstone cathedral is a marvel both outside and inside. It houses an old astronomical clock and a top platform to gaze at the whole city.Address: Place de la cathédrale, StrasbourgPhone: +33 3 88 214 334Website: http://www.cathedrale-strasbourg.fr
This is the most picturesque and romantic district of Strasbourg. The alleys offer a succession of old half-timbered houses and, thanks to canals, the river Ill gives visitors the feeling of strolling in Venice. Fluvial tours of 70 minutes with explanations in several languages are available.Address: Place du marché aux poissons, StrasbourgWebsite: http://www.strasbourg.port.fr
This is one of the major political places of the European Union, with Council of Europe, Palace of Human Rights and European Parliament all clustered close to the Rhine. Visits upon reservation only, but even a walk around those huge buildings is worth seeing.Address: Avenue de l'Europe, StrasbourgPhone: +33 3 8841 2029Website: http://www.coe.int / http://www.europarl.eu
Maison Kammerzell is nowadays turned into a restaurant. This house is definitely the most beautiful one in Strasbourg thanks to the marvellous sculpted framework ornating the upper floors. The architecture is late Gothic and simply a must to visit.Address: 16 Place de la Cathédrale, StrasbourgPhone: +33 3 8832 4214Website: http://www.maison-kammerzell.com
An audio-guided tour is one of the best ways to discover all of Strasbourg at its own rhythm. The guides take about 90 minutes and are available in five languages.Address: 17 Place de la Cathédrale, StrasbourgPhone: +33 3 8852 2828More info: Tourist office
Le musée Alsacien is located in former Strasbourg homes, this museum is a must for discovering Alsatian traditions. The museum gives a great insight of Strasbourg´s art and folk tradition.Address: 23-25 Quai Saint-Nicolas, StrasbourgPhone: +33 3 8852 5001Website: http://www.musees-strasbourg.org
This memorial presents the stages in the bloody history of Alsace and Moselle people who changed nationality 4 times between 1870 and 1945. They have free self-guiding tours.Address: Lieu dit du Chauffour, Allee du souvenir français, SchirmeckPhone: +33 3 8847 4550Website: http://www.memorial-alsace-moselle.com
Welcome to an interesting journey into beer world, in this still-active factory. Of course you will be able to sample at the end of the visit (French, English and German tours).Address: 4 rue Saint Charles, Schiltigheim, StrasbourgPhone: +33 3 8819 5755Website: http://www.heinekenfrance.fr
Les Secrets du Chocolat is 800 m² entirely devoted to cocoa. One of the best things is that 100 grams of chocolate is offered to each person at the end of the visit.Address: rue du Pont du Péage, StrasbourgPhone: +33 3 8855 0490Website: http://www.musee-du-chocolat.comMore info: Parc de la Porte Sud
Strasbourg is known for its gastronomy. Discover the richness of Alsace's cuisine and specialties like choucroute, flammeküche, Bäckeoffe, Christmas cookies… in the friendly atmosphere of a typical winstub. In spring, when the nature revives, the gastronomic routes invite you to discover the Alsatian cuisine and wines.
This is a chic restaurant with a refined and inventive cuisine, in a modern interior. It is located just a few steps from the cathedral and their delicious menu is refreshed every five weeks.Address: 77 Grand'Rue, StrasbourgPhone: +33 3 8832 2337
With one star in the prestigious "Guide Michelin," this restaurant is one of the best addresses for discerning gourmets. Their dishes are refined after season and the sommelier will help you with which wine goes best to your food.Address: 21 rue du général de Gaulle, StrasbourgPhone: +33 3 8859 2480Website: http://www.relais-poste.com
Thanks to the renowned chef, this restaurant has established a reputation as being the place to go for seafood, which comes directly from Brittany. The interior, just as the food, has a lot of character.Address: 42 Rue de la Krutenau, StrasbourgPhone: +33 3 8824 0877Website: http://www.lepontauxchats.fr
A "winstub" is a typical Alsatian restaurant, with local dishes. Chez Yvonne is probably the most famous one of Strasbourg. The service is friendly and the portions generous.Address: 10 Rue du Sanglier, StrasbourgPhone: +33 3 8832 8415Website: http://www.restaurant-chez-yvonne.net
L'Ancienne Douane serves traditional cuisine, like the place itself and the waiters, who are all dressed in Alsatian costumes. If the weather permits and if there is place, take a seat on the balcony and enjoy the beautiful views over the water.Address: 6 Rue de la Douane, StrasbourgPhone: +33 3 8815 7878Website: http://www.anciennedouane.fr
Les Deux Gourmandes - the two gourmets - has a warm family atmosphere. Enjoy the cosy interior a long with the wide variety of local dishes.Address: 1 Rue des Serruriers, StrasbourgPhone: +33 3 8832 4547
Poêles de Carottes is a very good vegetarian restaurant with 40 percent of the products used classified as "biological." Many interesting dishes and drinks, like pumpkin beer.Address: 8 rue Râpe, StrasbourgPhone: +33 3 8832 3323
This franchise chain offers small prices, but huge and delicious sandwiches and salads. This is the perfect place to make your dream sandwich.Address: 7 Place Saint-Nicolas aux Ondes, StrasbourgPhone: +33 3 8824 0708Website: http://www.madein-strasbourg.fr
La Place is one of the trendiest cafés of Strasbourg. The location and the atmosphere of the café makes this an ideal spot for having a drink and snack.Address: 3 Place des Tripiers, StrasbourgPhone: +33 3 8822 2220
Everything is for sale in this special place, where artists come to have a drink. If you haven't got enough money to pay, you can also barter one of your belongings!Address: 8 Rue du Faubourg de Saverne, StrasbourgPhone: +33 3 8823 2329Website: http://www.facebook.com/letrocafe
This is a nice café for drinking everything – even soups from 6 pm! There is also internet is available in a separate room if needed.Address: 10 Quai des Pêcheurs, StrasbourgPhone: +33 3 8835 1060
Atlantico is hard to miss as it is located on a red boat. This café is a popular place with very affordable prices and delicious sweets.Address: Quai des pêcheurs, StrasbourgPhone: +33 3 8835 7781Website: http://www.cafe-atlantico.net
This is a chic address close to the opera. Café de l'Opéra is perfect for eating French pastries and drinking fresh fruit juices.Address: 19 Place Broglie, StrasbourgPhone: +33 3 8822 9851Website: http://www.cafedelopera.fr
Strasbourg is a young and dynamic city. A whole new world opens its doors when the night falls. There are a lot of nice places in the city. Some areas are known for their bars or their concert halls, whereas the Krutenau district is particularly popular for students for its bars and nightclubs. Along the quays, the party continues in bars or on a barge. In Strasbourg, you have the possibility to spend good time.
With sixty different types of champagne, this bar / lounge, ideally located in the Petite France, is your best bet to drink prestigious champagne.Address: 5 rue des Moulins, StrasbourgPhone: +33 3 8876 4343Website: http://www.regent-petite-france.com
L'épicerie is a beautifully decorated old bar, which has several local wines and singular syrups. French music is never far away and set the perfect mood for a lovely evening.Address: 6 Rue du Vieux Seigle, StrasbourgPhone: +33 3 8832 5241Website: http://www.lepicerie-strasbourg.com
Jeanette et les cycleux has a special atmosphere with an antique red moped attached to the wall. It will plunge you into the '60s and '70s spirit.Address: 30 rue des Tonneliers, StrasbourgPhone: +33 3 8823 0271Website: http://www.lenetdejeannette.com
Tapas café has delicious hot and Spanish atmosphere with many types of tapas to be served with your drink. The fiery mojito is never a bad choice to start off the night.Address: 16 Rue du Bain Finkwiller, StrasbourgPhone: +33 3 8824 5730Website: http://www.tapas-cafe.fr
Welcome to this bar, restaurant and club. L'académie de la Bière always has a good clientele until the small hours.Address: 17 Rue Adolphe Seyboth, StrasbourgPhone: +33 3 8822 3888Website: http://www.academie-biere.com
Concerts, one-man shows and stage improvisations are common in this trendy club. They have many types of wines and beers.Address: 14 Rue Georges Wodli, StrasbourgPhone: +33 3 8832 1260Website: http://www.au-camionneur.fr
As it's written (java means party), this place, always full of students, is well-known for dancing and drinking. At La Java you will not have a dull moment.Address: 6 Rue du Faisan, StrasbourgPhone: +33 3 8836 3488Website: http://www.lajava.net
Strasbourg Airport is located 18 kilometres southwest of the town centre. A shuttle train stops at the airport and takes you to Strasbourg Station. The journey to Strasbourg Station takes 9 minutes and the train leaves up to 4 times every hour.Phone: +33 3 8864 6767Website: http://www.strasbourg.aeroport.fr


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7 U.S. Code § 2204b - Rural development policy
(a) Coordination of nationwide rural development program using services of executive branch departments and agencies and State and local governments
The Secretary of Agriculture shall provide leadership within the executive branch for, and shall assume responsibility for coordinating, a nationwide rural development program using the services of executive branch departments and agencies, including, but not limited to, the agencies, bureaus, offices, and services of the Department of Agriculture, in coordination with rural development programs of State and local governments.
(b) Policy development; systematic review of Federal programs; access to information; development of process to receive and assess needs, goals, etc.; cooperative agreements to improve Federal programs affecting rural areas; public hearings and comments
(1) The Secretary shall conduct a systematic review of Federal programs affecting rural areas to
(A) determine whether such areas are benefiting from such programs in an equitable proportion to the benefits received by urban areas and
(B) identify any factors that may restrict accessibility to such programs in rural areas or limit participation in such programs.
(2) Subject to the Privacy Act of 1974 [5 U.S.C. 552a], the Secretary may secure directly from any Federal department or agency information necessary to carry out the Secretary's duties under this section. Upon request of the Secretary under this paragraph, the head of any such Federal department or agency shall furnish such information to the Secretary.
(3) The Secretary shall develop a process through which multistate, State, substate, and local rural development needs, goals, objectives, plans, and recommendations can be received and assessed on a continuing basis. Such process may include the use of those rural development experts, advisors, and consultants that the Secretary deems appropriate, as well as the establishment of temporary advisory committees under the terms of the Federal Advisory Committee Act.
(4) Cooperative agreements.—
(A) In general.— Notwithstanding chapter 63 of title 31, the Secretary may enter into cooperative agreements with other Federal agencies, State and local governments, and any other organization or individual to improve the coordination and effectiveness of Federal programs, services, and actions affecting rural areas, including the establishment and financing of interagency groups, if the Secretary determines that the objectives of the agreement will serve the mutual interest of the parties in rural development activities.
(B) Cooperators.— Each cooperator, including each Federal agency, to the extent that funds are otherwise available, may participate in any cooperative agreement or working group established pursuant to this paragraph by contributing funds or other resources to the Secretary to carry out the agreement or functions of the group.
(c) Rural development strategy and annual updates; preparation and scope; purposes; time for updates; public hearings and suggestions and recommendations; transmittal to Congressional committees; analysis of budgetary considerations and factors; evaluation and recommendations regarding implementation and revisions
(1) The Secretary shall prepare a comprehensive rural development strategy based on the needs, goals, objectives, plans, and recommendations of local communities, substate areas, States, and multistate regions, which is designed to—
(A) maximize the effectiveness, increase the responsiveness, and improve the delivery of Federal programs to rural areas;
(B) increase the coordination of Federal programs with the development needs, objectives, and resources of local communities, substate areas, States, and multistate regions; and
(2) The rural development strategy shall take into account the need to—
(A) improve the economic well-being of all rural residents and alleviate the problems of low income, elderly, minority, and otherwise disadvantaged rural residents;
(B) improve the business and employment opportunities, occupational training and employment services, health care services, educational opportunities, energy utilization and availability, housing, transportation, community services, community facilities, water supplies, sewage and solid waste management systems, credit availability, and accessibility to and delivery of private and public financial resources in the maintenance and creation of jobs in rural areas;
(C) improve State and local government management capabilities, institutions, and programs related to rural development and expand educational and training opportunities for State and local officials, particularly in small rural communities;
(3) The rural development strategy developed under this subsection shall be for the fiscal year ending September 30, 1982, and updated for each fiscal year thereafter.
(4) The Secretary shall hold public hearings and receive such suggestions and recommendations as the Secretary deems appropriate during the preparation of the rural development strategy and the annual updates to the strategy.
(5) The rural development strategy and the annual updates to the strategy shall be transmitted to the House Committee on Agriculture and the Senate Committee on Agriculture, Nutrition, and Forestry by January 31 of the calendar year immediately preceding the beginning of the appropriate fiscal year.
(6) The rural development strategy and each annual update of the strategy shall contain an analysis of the budget recommendations of the President for the fiscal year following the transmittal of the strategy or update of the strategy and of all the available budget projections of the President for subsequent fiscal years, and projections regarding the budget that are relevant or essential to the rural development policy and the rural development strategy developed under this subsection. Each annual update shall also contain a detailed statement of the findings and conclusions of the Secretary regarding the implementation during the preceding fiscal year of the rural development strategy, including any revisions of the strategy, any recommended legislation to improve the rural development effort of the Federal Government, and an evaluation of and recommendations regarding the rural development information system required under section 1926 (a)(12) of this title.
(d) Strategy implementation; goals
The Secretary shall ensure the effective implementation of the rural development strategy and maximize coordination of Federal programs affecting rural areas through a systematic effort to—
(1) improve communication and encourage cooperation among Federal departments and agencies in the administration of rural development programs;
(2) eliminate conflicts, duplication, and gaps in program coverage, and resolve contradictions and inconsistencies in the objectives, administration, and effects of rural development programs;
(3) facilitate the sharing or common location of field offices of Federal agencies administering similar or complementary programs and unification of delivery systems, where feasible, to maximize convenience and accessibility of such agencies and programs to rural residents;
(5) correct administrative problems in Federal programs that delay or hinder the effective delivery of services, assistance, or benefits to rural areas; and
Source(Pub. L. 92–419, title VI, § 607, as added Pub. L. 96–355, § 2,Sept. 24, 1980, 94 Stat. 1171; amended Pub. L. 104–127, title VII, § 759A,Apr. 4, 1996, 110 Stat. 1138.)
References in Text
The Privacy Act of 1974, referred to in subsec. (b)(2), is Pub. L. 93–579, Dec. 31, 1974, 88 Stat. 1896, as amended, which enacted section 552a of Title 5, Government Organization and Employees, and provisions set out as notes under section 552a of Title 5. For complete classification of this Act to the Code, see Short Title note set out under section 552a of Title 5 and Tables.
The Federal Advisory Committee Act, referred to in subsec. (b)(3), is Pub. L. 92–463, Oct. 6, 1972, 86 Stat. 770, as amended, which is set out in the Appendix to Title 5.
1996—Subsec. (b)(4). Pub. L. 104–127added par. (4) and struck out former par. (4) which read as follows: "The Secretary may undertake cooperative efforts with other Federal departments and agencies to improve the coordination and effectiveness of Federal programs, services, and actions affecting rural areas. The Secretary may request the heads of other Federal departments and agencies to participate in any working groups that the Secretary deems necessary to carry out the purposes of this section."
Effective Date
Pub. L. 96–355, § 10,Sept. 24, 1980, 94 Stat. 1176, provided that: "The provisions of this Act [enacting this section and section 2211b of this title, amending sections 1926, 2204, 2204a, 2204b–1, 2663, and 2667 of this title and section 5314 of Title 5, Government Organization and Employees, and enacting provisions set out as a note under section 2201 of this title] shall become effective October 1, 1980."
Termination of Reporting Requirements
For termination, effective May 15, 2000, of provisions in subsec. (c)(5) of this section relating to transmittal of rural development strategy annual updates to certain committees of Congress, see section 3003 ofPub. L. 104–66, as amended, set out as a note under section 1113 of Title 31, Money and Finance, and page 44 of House Document No. 103–7.
Transfer of Functions
Powers, duties, and assets of agencies, offices, and other entities within Department of Agriculture relating to rural development functions transferred to Rural Development Administration by section 2302(b) ofPub. L. 101–624.
Simplified, Uniform Application for Assistance From All Federal Rural Development Programs
Pub. L. 104–127, title VII, § 762,Apr. 4, 1996, 110 Stat. 1148, provided that: "Not later than 1 year after the date of enactment of this Act [Apr. 4, 1996], the Secretary of Agriculture shall develop a streamlined, simplified, and uniform application which shall be used in applying for assistance under all of the following:
"(1) Sections 304 (b), 306, 306A, 306C, 306D, 310B, and 375 [former 7 U.S.C. 2008j] and subtitle E [7 U.S.C. 2009 et seq.] of the Consolidated Farm and Rural Development Act (7 U.S.C. 1924 (b), 1926, 1926a, 1926c, 1926d, and 1932).
"(2) Subtitle G of title XVI and sections 2281 [42 U.S.C. 5177a], 2333, and 2381 of the Food, Agriculture, Conservation, and Trade Act of 1990 (7 U.S.C. [former] 5901–5908, 5177a, 950aaa–2, and 3125b).
"(3) Subtitle C of title IX of the Food, Agriculture, Conservation, and Trade Act Amendments of 1991 (Public Law 102–237:[;] 7 U.S.C. [former] 5930 note).
"(5) Title V and section 603(c) of the Rural Development Act of 1972 (7 U.S.C. 2661–2669 and 2204a (c)).
"(6) Sections 5 and 311 and title IV of the Rural Electrification Act of 1936 (7 U.S.C. [former] 905, [former] 940a, and 941–950b)."
Executive Order No. 12720
Ex. Ord. No. 12720, July 16, 1990, 55 F.R. 29337, as amended by Ex. Ord. No. 12783, Dec. 17, 1991, 56 F.R. 65977, which established the President's Council on Rural America, was revoked by Ex. Ord. No. 12869, § 4(c), Sept. 30, 1993, 58 F.R. 51751, formerly set out as a note under section 14 of the Federal Advisory Committee Act in the Appendix to Title 5, Government Organization and Employees.
Ex. Ord. No. 13575. Establishment of the White House Rural Council
By the authority vested in me as President by the Constitution and the laws of the United States of America and in order to enhance Federal engagement with rural communities, it is hereby ordered as follows:
Section 1. Policy. Sixteen percent of the American population lives in rural counties. Strong, sustainable rural communities are essential to winning the future and ensuring American competitiveness in the years ahead. These communities supply our food, fiber, and energy, safeguard our natural resources, and are essential in the development of science and innovation. Though rural communities face numerous challenges, they also present enormous economic potential. The Federal Government has an important role to play in order to expand access to the capital necessary for economic growth, promote innovation, improve access to health care and education, and expand outdoor recreational activities on public lands.
To enhance the Federal Government's efforts to address the needs of rural America, this order establishes a council to better coordinate Federal programs and maximize the impact of Federal investment to promote economic prosperity and quality of life in our rural communities.
Sec. 2. Establishment. There is established a White House Rural Council (Council).
Sec. 3. Membership. (a) The Secretary of Agriculture shall serve as the Chair of the Council, which shall also include the heads of the following executive branch departments, agencies, and offices:
(1) the Department of the Treasury;
(2) the Department of Defense;
(3) the Department of Justice;
(4) the Department of the Interior;
(5) the Department of Commerce;
(6) the Department of Labor;
(7) the Department of Health and Human Services;
(8) the Department of Housing and Urban Development;
(9) the Department of Transportation;
(10) the Department of Energy;
(11) the Department of Education;
(12) the Department of Veterans Affairs;
(13) the Department of Homeland Security;
(14) the Environmental Protection Agency;
(15) the Federal Communications Commission;
(16) the Office of Management and Budget;
(17) the Office of Science and Technology Policy;
(18) the Office of National Drug Control Policy;
(19) the Council of Economic Advisers;
(20) the Domestic Policy Council;
(21) the National Economic Council;
(22) the Small Business Administration;
(23) the Council on Environmental Quality;
(24) the White House Office of Public Engagement and Intergovernmental Affairs;
(25) the White House Office of Cabinet Affairs; and such other executive branch departments, agencies, and offices as the President or the Secretary of Agriculture may, from time to time, designate.
(b) A member of the Council may designate, to perform the Council functions of the member, a senior-level official who is part of the member's department, agency, or office, and who is a full-time officer or employee of the Federal Government.
(c) The Department of Agriculture shall provide funding and administrative support for the Council to the extent permitted by law and within existing appropriations.
(d) The Council shall coordinate its policy development through the Domestic Policy Council and the National Economic Council.
Sec. 4. Mission and Function of the Council. The Council shall work across executive departments, agencies, and offices to coordinate development of policy recommendations to promote economic prosperity and quality of life in rural America, and shall coordinate my Administration's engagement with rural communities. The Council shall:
(a) make recommendations to the President, through the Director of the Domestic Policy Council and the Director of the National Economic Council, on streamlining and leveraging Federal investments in rural areas, where appropriate, to increase the impact of Federal dollars and create economic opportunities to improve the quality of life in rural America;
(b) coordinate and increase the effectiveness of Federal engagement with rural stakeholders, including agricultural organizations, small businesses, education and training institutions, health-care providers, telecommunications services providers, research and land grant institutions, law enforcement, State, local, and tribal governments, and nongovernmental organizations regarding the needs of rural America;
(c) coordinate Federal efforts directed toward the growth and development of geographic regions that encompass both urban and rural areas; and
(d) identify and facilitate rural economic opportunities associated with energy development, outdoor recreation, and other conservation related activities.
Sec. 5. General Provisions. (a) The heads of executive departments and agencies shall assist and provide information to the Council, consistent with applicable law, as may be necessary to carry out the functions of the Council. Each executive department and agency shall bear its own expense for participating in the Council.
(b) Nothing in this order shall be construed to impair or otherwise affect:
(i) authority granted by law to an executive department, agency, or the head thereof; or
(ii) functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.
(c) This order shall be implemented consistent with applicable law and subject to the availability of appropriations.
(d) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.Barack Obama.
LII has no control over and does not endorse any external Internet site that contains links to or references LII.


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What is Dressing Your Truth?
Dressing Your Truth is an educational service designed to teach you about your unique Type of beauty, give you insights and tools to feel more confident and look more beautiful, and provide products that make your shopping experience easy and affordable.
This practical, intuitive beauty makeover system empowers you to look and feel your best.
How the Fashion World Has Failed You
How do you feel after looking at a fashion magazine?
A majority of women feel worse after only 3 minutes of thumbing through one.
The supermodel standard only portrays a small sliver of the spectrum of beauty. But women everywhere feel inferior for not fitting into it. On top of that, the fashion industry introduces new colors, new trends, and new rules every few months.
The fashion industry tells you to put beauty on. But what if you could bring beauty—your true beauty—out?
Where Dressing Your Truth Comes In
Every woman is beautiful. Every woman.
And we're not just talking inner beauty.
That's why Carol Tuttle has created Dressing Your Truth, a comprehensive fashion system that turns long-standing fashion myths on their heads and empowers women of every age, shape, and size with tools to look and feel amazingly beautiful every single day.
The First Step to Dressing Your Truth
The first step is to discover your unique Type of beauty with the free BEAUTY PROFILING℠ Course.
This quick course provides information to assess and advise you about your specific energetic movement, personality characteristics, and facial features.
This information is available long distance, as all our pre-recorded audio and video presentations are available online.
It's self-improvement meets clothes shopping.
Women who dress their truth know they are full of natural beauty, inside and out, and they express it beautifully with everything they put on.
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Upright Citizens Brigade Improvisation and Sketch Comedy Training Center
(7824) Advanced Study Harold Wednesdays 7-10pm Abra Tabak
Advanced Study Harold: Advanced Harold Workshop
- Prerequisites
- Completion of 401; Acceptance to Advanced Study Improv
- Scheduled
- Wednesdays 7-10pm
- Start Date
- Wed January 2, 2013, 7:00pm EST
- Price
- $400.00
Each master class course offered at this level is instructor-driven. Students will get to study the Harold and related performance pieces at an advanced level and will receive in-depth personal feedback about their own performance and progress as improvisers.
Advanced Harold Workshop with Abra Tabak
Description: This class will focus on supporting your scene partner and your teammates throughout the Harold. Emphasizing listening and reacting to everything said and grounding the scene with truthfulness. This class will also include personal notes from Abra and side coaching.
Students must be accepted into the Advanced Study Program to register for this course. For more information on Advanced Study, see this page: http://newyork.ucbtheatre.com/classes/advanced
If you are approved for Advanced Study and wish to take this class please EMAIL [email protected] with the subject "Advanced Study Harold Permission Class A Tabak 7824". Even if you have received permission to register for previous Advanced Study courses, you still need to send an email and wait for a reply.
Note: Spaces in the course will be allotted to students in the order that application emails are received. The status of the course may change to "Sold Out" and back to "Request Permission" when students are being enrolled, but you do NOT need to reapply to this class if that happens. Your original email request will be kept on file and you will be contacted if a space becomes available for you.
Abra Tabak, Teacher
She currently improvises every Saturday night at the Upright Citizens Brigade Theatre with Grandma's Ashes and on Friday nights in "What I Did For Love."She can also be seen performing across the country with the UCB Touring Company.
ScheduleAdd to Calendar
This Course is Completed.


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Photo by Chris Lilly
YIELD: Makes 12 to 14 skewers
- 28 shiitake mushroom caps
- 3/4 cup soy sauce
- 3/4 cup mirin (rice wine)
- 1/2 cup sugar
- 1/4 cup water
- Juice of 1/2 lime
- 1 tablespoon chopped fresh cilantro
- 1 clove garlic, minced
- 3/4 teaspoon peeled, grated fresh ginger
- 1/8 teaspoon hot red pepper flakes
- 1 (1 1/2-to 2-pound) flank steak
- 1 bunch scallion tops
- 1 teaspoon salt
- 1 teaspoon freshly ground black pepper
Place 12 to 14 (4-inch) skewers in water to soak.
Cut the shiitake mushroom caps in half and place them in a mixing bowl. In a medium saucepan, combine the marinade ingredients and bring to a simmer; simmer for 10 minutes. Remove from the heat and pour the hot liquid over the mushroom caps. Marinate for 20 minutes.
Cut the flank steak across the grain into 1/4-inch strips. Cut the scallion tops into 1-inch pieces.
Remove the mushrooms from the marinade and set the marinade aside. Use a skewer to pierce the flank steak at the end of the strip. Next pierce a piece of mushroom cap, followed by a scallion top. Weave the flank steak strip around the mushroom and scallion and continue skewering mushroom, scallion, and flank steak until the steak strip ends. Lightly season the skewers with salt and pepper.
Preheat a hot grill. Dip each skewer into the leftover marinade and place on the grill over direct heat. Grill for 2 minutes on each side, or until the steak browns. Remove the skewers from the grill and serve.
Reprinted with permission from America's Best BBQ, Homestyle by Ardie A. Davis and Chef Paul Kirk, © 2013 Andrews McMeel Publishing
my notes
Nutritional Info
- Calories193
- Carbohydrates15 g (5%)
- Fat6 g (9%)
- Protein17 g (34%)
- Saturated Fat2 g (11%)
- Sodium1,112 mg (46%)
- Polyunsaturated Fat0 g
- Fiber2 g (8%)
- Monounsaturated Fat2 g
- Cholesterol45 mg (15%)


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Isles of Capri Boat Parade 2011
Saturday night Isle or Capri residents were treated to the biggest holiday boat parade the island community has seen yet. The annual event, now in its eighth year, boasted 15 boats. From larger-than-life reproductions of Santa's sleigh (complete with reindeer and all), to a giant dragon that exhaled smoke (made by shooting flour out of an air compressor), this year's boat parade was not-to-be-missed.


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A 32-year-old Iranian who is a U.S. citizen and a Christian pastor is being held in prison in Iran, and is expected to face charges for rejecting Islam and preaching the gospel in his native country. Fox News reported that in September the Rev. Saeed Abedini, who lives in the United States with his American wife and two young children, "was making one of his frequent visits to see his parents and the rest of his family in Iran, his country of origin and where he spent many years as a Christian leader and community organizer developing Iran's underground home church communities for Christian converts."
According to Abedini's wife, Naghmeh, on September 26 a group of men burst into his parents' home in Tehran, where Abedini was staying, hauling him off to jail and placing his parents and other family members under house arrest. Thus far Iranian authorities have been mum on Abedini's plight, but his wife said he has been confined to Evin Prison, which has a reputation for extreme brutality, and his life has been threatened.
"When he became a Christian, he became a criminal in his own country," Naghmeh told Fox News. "His passion was to reach the people of Iran. He comes from a very close-knit family, and he loved evangelizing and passing out Bibles on the streets of Tehran. This was his passion."
Naghmeh, who married Abedini in 2005 after making a trip to Iran, said that her husband became a Christian after training with a radical Muslim group to become a suicide bomber. She said that Abedini became very depressed as a result of the intense training and that "Christianity saved his life."
Abedini ultimately became a leader in Iran's underground church, and before leaving the country, oversaw about 100 churches and 2,000 members in 30 Iranian cities. Naghmeh said her husband's role as a Christian leader drew the ire of Muslim authorities in the country. "They see the underground churches as a threat and they see Christianity as a tool from the West to undermine them," she told Fox. "They think if the country becomes more Christian, they are no longer under Islamic authority. That's why it's a threat."
Click here to read the entire article.


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EPA New England Topics
Air Quality (Particulate Matter and Regional Haze)
This page provides links to non-EPA web sites that provide additional information about Air Quality (Particulate Matter and Regional Haze). You will leave the EPA.gov domain and enter another page with more information. EPA cannot attest to the accuracy of information on that non-EPA page. Providing links to a non-EPA Web site is not an endorsement of the other site or the information it contains by EPA or any of its employees. Also, be aware that the privacy protection provided on the EPA.gov domain (see Privacy and Security Notice) may not be available at the external link.
Can't find what you need? Try our A-Z Index.
EPA New England
Air Quality Index Page
Real-time and forecasted air pollution data in an understandable visual format
Particulate Matter (PM) in New England
Regional Contacts for Particulate Matter, Diesel Vehicles Programs, and Regional Haze
EPA National
Particulate Matter Health Effects
Revised Particulate Matter Standards (2006)
Trends in PM Levels and Direct Emissions
Regional Transport of PM and the Clean Air Interstate Rule (CAIR)
Visibility Improvement Program
Plain English Guide to the Clean Air Act
Real-time PM 2.5 Data for Boston, MA
Visibility Cameras for Selected Northeast Locations
National Park Service Visibility Program


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|Stock Maven®


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#6 - Robbie Johnson
|2011-12 Men's Soccer
Geneva, Ill. (Geneva HS)
2013 (Junior): Named to the A-Sun Academic All-Conference Team for the second straight season...Named to the Hyatt Place Select Lipscomb Invitational and the Mafiaoza's Belmont Invitational All-Tournament Teams...Played in and started 19 games...Helped anchor a defense that allowed a school NCAA record 20 goals including a school record seven shutouts...Attempted 16 shots placing six on goal...Assisted on the game-winning goal at USC Upstate...
2012 (Sophomore): Named to the A-Sun Academic All-Conference Team… Named to Mafiaoza's Belmont Invitational All-Tournament Team… Played in and started all 20 games… Attempted 15 shots placing eight on goal… Notched an assist in upset win over Florida Gulf Coast… Played every minute of every game until receiving a red card in final game of season…
2011 (Freshman): Appeared in nine matches, starting three... Started the first two games of the season against Georgia State (Aug. 26) and Memphis (Aug. 28)... Played a season-high 87 minutes against the Panthers... Played 80 minutes off the bench against Xavier (Sep. 4)... Took shots against Xavier and VMI (Sep. 9)... Made season's final start against Eastern Illinois (Sep. 22), where he played 57 minutes.
High School: Played for Ryan Estabrook at Geneva Community High School... All-State in 2010... All-Conference and academic All-Conference in 2009 and 2010... Scored 28 goals during his high school career... Played for Mark MacKinnon on the Campton United 92 club squad... As a Disney U17 All-Star in 2009, he attended the Chelsea Training Academy in London... Member of the National Honor Society.
Personal: Son of Thad and Teresa Johnson... Father was an F-16 Air Force fighter pilot... Has three siblings: Ben, Nick and Natalie... Plays piano... Plans to major in engineering... Chose Lipscomb because of its Division I soccer program and engineering educational opportunities.
|Copyright ©2015 Lipscomb University Athletics. All Rights Reserved.


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|Product #: SDLSP7232I_TQ
Building Vocabulary Skills and Strategies Level 5 (Enhanced eBook) (Resource eBookGrade 10|Grade 11|Grade 12|Grade 3|Grade 4|Grade 5|Grade 6|Grade 7|Grade 8|Grade 9
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A great vocabulary program that is equally appropriate for younger students working at grade level and older students who have forgotten or never mastered the basics.
This enhanced eBook gives you the freedom to copy and paste the content of each page into the format that fits your needs. You can post lessons on your class website, make student copies, and more. For more information on enhanced eBooks, Click Here.
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Results 1 to 2 of 2
07-21-2011 #1
- Join Date
- Jul 2011
- Posts
- 1
JC PENNEY Mary Lu Playthings Piano
Does anyone have any information about a JC Penney Mary Lu Playthings green piano?
I am having a very hard time getting some info on this toy.
07-24-2011 #2
- Join Date
- Feb 2011
- Posts
- 754
I have looked all over and couldn't find a think on the piano you mention, but I did find this photo of the item in red, which was used as a prop for a photo shoot. The thing comparable from the Worthopedia is a Mary Lu Playthings hand cranking phonograph, which sold for $76 a few months ago. I am sorry I can't be more specifically helpful here. Anyone else have any ideas?
Tags for this Thread


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Academic Advising
UMUC embraces a team-based advising model to ensure accurate and timely information sharing between advisors and students. From the first time you enroll through graduation, UMUC academic advisors are available to assist with selecting and scheduling classes. Academic advisors will guide you through the steps that lead to a graduate-level degree or certificate.
To make every interaction with advising a seamless one, you can call, e-mail or visit our office at the Academic Center at Largo, and any of our academic advisors can assist you.
Graduate Advising Newsletter
Get Tips and Tricks for applying to graduate, answers to FAQs, and important semester dates! Read the January 2012 Graduate Advising Newsletter - Volume 6,
Getting Started
Helpful Links
- Schedule of Classes
- MBS Bookstore
- Financial Aid
- Office of Student Accounts
- Transfer Credit Information
- Golden ID Program
- Withdraw Dates
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Useful Information
Contact an Academic Advisor
Email: Graduate Advising
Phone: 800-888-UMUC (8682)
Fax: 240-684-2154
Hours of Operation:
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Need to check your student account?
Log in to MyUMUC to get your secured, individualized student information.


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Welcome to Hotel Etoile Saint-Honoré !
Discover its 85 spacious air-conditionned rooms and suites, tidily equipped and decorated. With its perfect location, the hotel can offer you an extraordinary view on the Western Paris, the Eiffel Tower or the Sacré Coeur.
Close to the Arc de Triomphe and the Palais des Congrès, it is the perfect starting point for all the trips you're planning around the capital.
The rooms, the large lobby and the breakfast room were harmoniously decorated in a chic, contemporary style.
On your arrival and throughout your stay, the living room comes to life late afternoon and offers you tea-time.
"The welcome from the staff, who are keen to please. The junior suite with views over Sacré-Cœur is really comfortable, spacious and very romantic. We wouldn't think twice about returning to this hotel!"
Sophie and Marc
"A very fine hotel with welcoming, professional staff. The room and breakfast was very good. Nothing to complain about, we had an excellent stay."
"Absolutely incredible, we couldn't have asked for better! This was especially true with a direct view of the Eiffel Tower from our room. We'll certainly be back."


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The name is One, but they're sold in pairs.
Socks just don't get the credit they deserve. A good pair of socks can be the difference between a great time and a death march. One Industries Blaster MTB Socks have all the makings of a great ride — just add bike and trail. You'll want a pair of shoes, too.
Blasters are made with thin, moisture-wicking material. The ribbed arch provides the support you need to keep from getting achy feet. Four-way stretch toe and heel impact zones provide shock-absorption and help reduce fatigue, and the light mesh weave at the calf and foot vamp keeps your feet dry and cool.
One Industries Blaster MTB Socks - Men's are available in sizes 7-9 and 10-12, and they come in Chartreuse/black, Black/chartreuse, White/black, Black/red, and Black/orange.
Tech Specs
View more Bike Socks
Community & Reviews
What do you think of the
One Industries Blaster MTB Socks - Men's
? Share a...
Good ventilation
Good ventilation
Good fit
Eric B.
Good Fit
- Familiarity: I've used it several times
- Fit: True to size
A great sock. The fit is very comfortable and they have been pretty durable so far.
Cam Phillips
Inconsistent sizing and fit
- Familiarity: I've put it through the wringer
I like these socks, but they are very inconsistent with the sizing and fit. The black/red ones come up almost to my knees, the black/green are mid-calf, and the gray/orange fit like crew socks (and the fabric feels different, coarser). I still wear and enjoy them, but I'm glad I got them on sale.
Laura K Stewart
Tall and Bright
- Familiarity: I've put it through the wringer
These rowdy lime socks are a winner.
Very comfortable, and durable. I have had them for over a year and after many rides and washer are still in perfect shape.
Be warned they are a tight at first but will stretch a little over time.
Good Action!
While these aren't quite the compression socks that the Fox DH's are, they work great and they run higher up the leg than the Fox's so I really like em. The weave isn't quite as tight as the Fox, but so far they're holding up. Been using them for Ice Hockey to give them the double down eval. The high-vis cuff is an added bonus. Anything that keeps people on the trail in their "Lily Fields" (not paying attention) from putting you in a cast is good action!
Keep you posted...
Colorado Chris
high and compression
- Familiarity: I've put it through the wringer
If you like compression in your socks and like them high then you'll love these. They take both hands to put on b/c the compression is rather tight. You have to inch worm them up. They are light and thin and summer socks. The compression is just a tad too much and even though I like tall socks these are pushing it for my taste.
Not As Expected
- Familiarity: I've used it several times
Too much compression for me compared to other MTB socks. Socks are tall (can pull up to knee), and a thin material. I have a very average 10.5 mens foot. I've been very happy with other One Industries products from Competitive Cyclist, but this one is a bit off. Do love the color though!
Amanda B.
- Familiarity: I've put it through the wringer
I bought these socks for road cycling because of the bright lime color, which is great for visibility... and it happens to match my team kit. These socks have mild compression, which makes them hold their shape well after many washes. Also, the compression is ideal for all riding distances, but particularly good for long distance rides. Just purchased my third pair, because a great pair of socks is hard to find.


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The EOS 60Da is compatible with all Canon lenses in the EF and EF-S lineup, ranging from ultra-wide angle to super telephoto lenses. Canon lenses employ advanced optical expertise and micron-precision engineering to deliver unprecedented performance in all facets of the photographic process. Special optical technologies, such as aspherical, ultra-low dispersion, or fluorite elements are featured in the universally acclaimed L-series lenses. And Canon's Optical Image Stabilizer technology is featured in select lenses to minimize the effect of camera shake. Additionally, the lenses used for astrophotography are compatible with every other EOS SLR; Canon wide-angle, macro, super-telephoto, tilt-shift and fisheye lenses provide a wealth of focal lengths, depth-of-field and other creative shooting options.
Canon offers a host of accessories to help photographers make the most of the EOS 60Da's powerful features. For long exposures using Live View, the AC Adapter Kit ACK-E6 provides a constant source of AC power to the camera. For composing through the viewfinder, Angle Finder C enables an adjustable viewing angle while providing a 2.5x magnification for critical focusing with a full screen image that also shows exposure data. Battery Grip BG-E9 enables the use of AA batteries or two LP-E6 batteries and adds the convenience of access to all the cameras features in both portrait and landscape orientation.
Prices and specifications subject to change without notice. Actual prices are determined by individual dealers and may vary.


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- Northern New York Newspapers
- Watertown
- Ogdensburg
- Massena-Potsdam
- Lowville
- Carthage
- Malone
- NNY Business
- NNY Living
- NNY Ads
RENSSELAER FALLS – The office of state Sen. Patricia A. Ritchie, R-Heuvelton, is working with a natural gas company to install service in the village after receiving a letter from a concerned resident.
The letter, written by village resident Bonnie M. St. Denny, requests that Mrs. Ritchie assist the village in obtaining a natural gas line.
Mrs. Ritchie was not available for comment, but her spokeswoman, Sarah Compo, said Mrs. Ritchie is currently in talks with St. Lawrence Gas to determine if the company can install a natural gas line in the village.
Mrs. St. Denny said she was pleased to hear that Mrs. Ritchie read her letter and offered to help.
Its nice that there is someone out there willing to help, she said. Ive talked with quite a few residents who would be happy to hear if and when the gas is available. It would be a great thing for the community.
Margaret S. Hance, former village mayor, said she had tried to convince a gas company in the late 1980s to install the infrastructure.
They [the gas company] told me it wouldnt have been be profitable then, and so it ended right there, she said.
Mrs. Hance, who runs her own tailoring business called Hance Originals, said she, too, would be interested in natural gas for her home and business.
Since she moved to village in 1968, Mrs. Hance said fuel oil has risen from 17 cents a gallon to $4.
It costs me between $400 and $600 every three weeks in winter to heat my house, she said. Its all terribly expensive.
Mrs. Hance said she hopes that with the passage of time and Mrs. Ritchies involvement, St. Lawrence Gas might consider installing the lines.
When I first asked for cable, they told me we might as well be on the moon, Mrs. Hance said. But they since came back and asked to install it. I hope the same happens here.
St. Lawrence Gas Assistant Manager James P. Ward was not available for comment Friday.
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