Posts tagged ‘Saving Humans’

April, 2014

Let’s heed the canary

Professor Rob MacKenzie

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IMAGE: Smog in the city (www.istockphotos.com)

Day three of southeast-England-in-the-murk, and still a pool of smoggy gloom catches your throat and wipes out the middle distance. This little week of blogs, with which I had hoped to engage with the large-scale and chronic challenges highlighted by the University of Birmingham’s Saving Humans theme, has — in the event — mutated into reflections on a local and acute threat to health and well-being. Such a change of focus may actually be for the better; perhaps through learning what pollution ‘feels like’ the debate about how to ameliorate the pollution that surrounds us every day can be reignited.

My suspicion is that there is a window of opportunity in public engagement with issues that are difficult to perceive directly most of the time. If nothing brings air pollution to our attention — really, tangibly to our attention — then we have to rely on expert opinion and ‘white-coat fatigue’ can set in. If we have to struggle through a pea-soup of pollution each and every day then it becomes easy to regard it as unavoidable and irremediable. But, in communities in which public engagement counts, sudden and perceptible reductions in quality of life can cause a commotion and galvanise governments into action.

Having issued the smog alerts and kept the message simple, scientific commentators are now beginning to fill-in some details. The analyses may, in the end, change our diagnosis of the event quite radically, reducing the role of Saharan dust and increasing the role of chemical production of particles in air travelling to us from Europe. A more complete diagnosis will enable policy-makers to consider options to minimise the risk of a repeat of these conditions in the future. Controlling local pollution would improve our chronic exposure to pollution and provide a little more ‘head room’ within which natural particle loadings and long-range transport of pollution can vary, but car bans and the like are unlikely to be a useful measure in the middle of episodes. International action to limit emission of the gases that react in the atmosphere to form particles looks to be necessary. Certainly we should not accept that there is nothing we can do simply because the particles did not, in the main, originate from within our borders.

International environmental regulation has enabled us to avoid catastrophic damage to the ozone layer and has outlawed many environmentally persistent poisons. Where, as in these instances, technological ‘fixes’ to industrial processes reduce the emission of pollutants, the chances of binding international agreement seem relatively high. Unfortunately, for smog, improving engine efficiency and fitting stack and tailpipe filters only gets us so far; human behaviour can subvert our best efforts. To go the next step towards clean air requires joined-up ‘systems thinking’ that, as the Intergovernmental Panel on Climate Change advocated this week, seeks win-win-win solutions, recognises that there will be unintended consequences, and privileges a love of life over incomplete measures of cost and benefit.

Professor Rob MacKenzie is Director, Birmingham Institute of Forest Research and Professor of Atmospheric Science, School of Geography, Earth and Environmental Sciences at the University of Birmingham.

April, 2014

The three-legged race to sustainability

Professor Rob MacKenzie

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Image: Dawn Smog (istockphoto.com)

The old adage says if you want to give God a laugh, tell her your plans. I had the best of intentions of putting all the cares of everyday academic life to one side for a day in order to enjoy the Trees, People & Built Environment conference, here at University of Birmingham. Then, late on Tuesday night, news began to filter through that weather patterns had conspired to produce a situation in which local air pollution, regional-scale pollution from north and central Europe, and Saharan dust were all contributing to an air pollution episode. So, instead of musing deeply on urban sustainability and our innate connection to “nature”, I spent the day saying what amounted to the content of the third sentence of this blog. Well, truth be told, I did manage to smuggle in a few sneaky references to what I think is really the “big picture” when we are confronted by one of these environmental episodes, be it flood, or heat wave, or smog: these are symptoms of a systems failure, and the system (or system-of-system) that is failing is UK land management.

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Image: Green City (istockphoto.com)

We can apply sticking plasters to a particular transport bottleneck, or a particular river, and relieve the problem for a while, only for it — or something quite different but subtly related — to pop up somewhere else. But perhaps there is another approach. I am feeling fired-up enough by Tuesday’s seminar on the biophilic city to venture an outlandishly ambitious vision: to reconfigure our relationship with “Nature” and with the City so that we break apart the old-fashioned dichotomy of town and country. Breaking these boundaries would usher-in a new view of human life: shared with every other form of life that can help us turn a linear highway to hell into a circular pattern of birth, death, regrowth. We have the visionaries to show us some of the way and we should not be scared to add to the canon of those ideas, so long as we recognise that ideas only work when in harness with strategy and serendipity. We are in a three-legged race to sustainability and, as I eventually learnt as a child, that can be an exhilarating race once you learn how not to fall over.

Professor Rob MacKenzie is Director, Birmingham Institute of Forest Research and Professor of Atmospheric Science, School of Geography, Earth and Environmental Sciences at the University of Birmingham.

April, 2014

Trees of life

Professor Rob MacKenzie

Welcome to a week of the Saving Humans blog focused predominantly on how the plant life with which we share the planet is saving, and can do even more to save, us. First and foremost amongst the plant life-savers are the plant crops we’ve domesticated and changed beyond all recognition for efficient production of food. This week, however, the focus will be more on trees: wild woodland and forest landscapes; trees in agricultural landscapes; parks and gardens; and trees in streets. The blogs coincide with the launch of the Birmingham Institute of Forest Research (BIFoR), an event to launch Birmingham as the UK’s first biophilic city, and the Trees, People & Built Environment conference of the Institute of Chartered Foresters.

The role and importance of the world’s woodlands and forests is hard to overstate: they prevent soil erosion, help in maintaining the water cycle, check global warming by using carbon dioxide in photosynthesis, provide recreational facilities, provide economic benefits, and are home to more than half of all species. Yet despite this the UK still has only 13% of its area given over to forest and the world’s forests are subject to continuing threats from emerging disease pandemics and from environmental change.

In response to these challenges, The University of Birmingham and the UK-based JABBS Foundation have invested £20million to establish the Birmingham Institute of Forest Research (BIFOR) that will address two fundamental and interrelated challenges: the impact of climate and environmental change on woodlands; and, the resilience of trees to invasive pests and diseases.

The Institute, which has secured initial funding for  ten years, will consist of refurbished laboratories and growth facilities on-campus, along with a large-scale, ground-breaking ‘free-air carbon dioxide enrichment’ (FACE) field facility that will enable globally leading scientists to take measurements from deep within the soil to above the tree canopy. The forest-FACE facility will be one of only two currently working worldwide (the other is in Australia) and one of only two that have ever attempted the experiment on a mature, mixed, semi-natural woodland.

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The Free-Air Carbon Dioxide Enrichment experiment at the Hawkesbury Institute of the environment, University of Western Sydney. Photograph courtesy Prof David Ellsworth.

The Free-Air Carbon Dioxide Enrichment experiment at the Hawkesbury Institute of the environment, University of Western Sydney. Photograph courtesy Prof David Ellsworth.

Autonomous sensors and instrumented trees will allow our scientists to take measurements continuously and remotely, over timescales ranging from seconds to decades. The facility will enable our ecologists, plant biologists, and environmental scientists to raise the concentration of CO2 in a specified area in an otherwise natural environment. By measuring the trees’ response, we will elucidate environmental risk and help developed and developing societies innovate to prepare, adapt and prosper to a future that is already set in-train by our current use of fossil fuels.

Yesterday saw the release of the Summary for Policymakers of the Working Group II contribution to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change — that is the non-technical summary of the part of the “IPCC report”, as it is known by scientists the world over, dealing with impacts, adaptation and vulnerability. The summary IPCC report weighing-up the evidence for man-made climate change was published in September 2013; the current part of the report is much about how we will feel climate change in almost every part of the Earth and in almost every part of society. The 44 pages of densely argued and comprehensively referenced text summarise many ways in which forests are under threat from climate change, each with the IPCC’s assessment of how confident they are in their statements:

“Carbon stored in the terrestrial biosphere (e.g., in peatlands, permafrost, and forests) is susceptible to loss to the atmosphere as a result of climate change, deforestation, and ecosystem degradation (high confidence). Increased tree mortality and associated forest dieback is projected to occur in many regions over the 21st century, due to increased temperatures and drought (medium confidence). Forest dieback poses risks for carbon storage, biodiversity, wood production, water quality, amenity, and economic activity.”

Thankfully, the report also points to the many ways — e.g. agroforestry projects and reforestation of coastal mangrove swamps in Asia — in which forests can be part of a solution or, at least, an accommodation to our changing environment. This upbeat identification of opportunities to change things for the better is the perfect introduction to this week’s series of blogs, so I leave the last word to the IPCC:

“Significant co-benefits, synergies, and tradeoffs exist between mitigation and adaptation and among different adaptation responses; interactions occur both within and across regions (very high confidence). …Examples of actions with co-benefits include …(ii) reduced energy and water consumption in urban areas through greening cities and recycling water; (iii) sustainable agriculture and forestry; and (iv) protection of ecosystems for carbon storage and other ecosystem services. (IPCC, WG2 SPM, p24)”.

Professor Rob MacKenzie is Director, Birmingham Institute of Forest Research and Professor of Atmospheric Science, School of Geography, Earth and Environmental Sciences at the University of Birmingham.

March, 2014

Surviving Burns and Overcoming Burns

Dr Jonathan Reinarz

One of the most interesting aspects of burns work undertaken by Archibald McIndoe during the Second World War (see Wednesday’s post) was the establishment of the Guinea Pig Club. The Guinea Pigs were members of WWII Royal Air Force air crews who had undergone at least two operations for their burns injuries at East Grinstead Hospital, where McIndoe was based. Originally intended to be a drinking club for patients whose injuries could be dangerously dehydrating (see Monday’s post), it counted 39 members at its launch in June 1941, a year after the Battle of Britain. By the end of the war, there were 649 Guinea Pigs, most of whom were British (62%), but it also included Canadians (20%), Australians (6%) and New Zealanders (6%); 80% had served as bomber crew during the war. As war historian Emily Mayhew has suggested, the Club was ‘an attempt to institutionalise the unique spirit of the patient community at East Grinstead’ in order to aid the psychological recovery of burn victims. Patients collectively attended operations, assisted newcomers and otherwise offered support to each other when necessary.

‘Dealing with Disfigurement’

Rather than hide away these severely disfigured airmen, McIndoe considered both their physical and (as he termed it) psychical wellbeing. He recognised that patients relied on their surgeon ‘for mental support, for hope and encouragement.’ But he also encouraged his patients to resume ordinary lives, often commencing with a joint visit to a local pub. Most wanted to resume normal lives, but their wounds often made this more difficult than expected. McIndoe knew that his patients would inevitably attract much attention the moment they ventured into town to frequent pubs or restaurants, so he prepared the residents of East Grinstead for potential encounters with patients, some of whom were mid-operation, with tube pedicle grafts nearly in place to reconstruct missing chins or noses. He also invited key members of the town into the wards, encouraging them to become ambassadors in the community by regularly hosting concerts and balls, where patients mingled with locals. In this way, he made the residents of East Grinstead recognise and accept his patients and focus on their contributions to society, rather than their disfigurements. In the process, East Grinstead became known as ‘the town that didn’t stare’, while the hospital developed an international reputation for its Maxilla-Facial Unit. The staff was so successful at its work that 80% of aircrew patients eventually returned to flying duties. Such success continued into peacetime, but the details of McIndoe’s civilian work has been less documented. Despite the positive experiences of East Grinstead Guinea Pigs, many inevitably faced challenges when they re-entered their former communities. That said, many had learned how to deal with these difficult encounters from their membership of the Guinea Pig Club; a group of about 60 original members continue to meet.

Psychological support for burns patients has continued to grow since 1941. The emotional load on staff at burns units has also been recognised, with many practitioners expressing their own challenges coping with the onerous duties involved in caring for these unique patients. Unusually, when Guinea Pigs visited America following the war, their faces were kept out of the press for fear of alarming the public. Americans would inevitably learn about the psychological impact of burns in their own ways. The 1942 Coconut Grove nightclub fire in Boston was not the worst urban fire in twentieth-century America, but it had a huge impact on burns treatment. Besides directing attention to the consequences of inhalation injury, it provided valuable insights into the immediate and long-term psychological impact of severe burns and the importance of supporting patients after their physical wounds healed. As obvious as some of these lessons were, it seems they need to be relearned every decade or so. More often these days, the memories of disasters, collective and individual, are kept alive by patient groups. Many American victims of burns and scalds owe their emotional recovery to the Phoenix Society for Burn Survivors, a national organisation dedicated to burns patient support, public education and advocacy.  In Britain, patients with burns receive the support of similar organisations, including Changing Faces, BurnAid and the Katie Piper Foundation. So successful have burns units become at saving humans that their challenges have shifted. Many victims now expect medical teams to save lives and even restore former appearances. It is with such expectations that support groups also help a new generation of patients.

New portrait of Simon Weston recently unveiled at the National Portrait Gallery.

New portrait of Simon Weston recently unveiled at the National Portrait Gallery.

Jonathan Reinarz wishes to thank Emily Mayhew, Rebecca Wynter, Naiem Moiemen, Tony Metcalfe, Shah Mamta, Ken Dunn and James Partridge for their help with his research.

Dr Jonathan Reinarz is Director of The History of Medicine Unit and a Reader in the History of Medicine at the University of Birmingham.

March, 2014

Burns and Infections: The Birmingham Accident Hospital

Dr Jonathan Reinarz

Nearly 60% of burns patients die of infections contracted after their initial injuries. Historically, burns-related infections have proved particularly challenging. Burn wounds contain devitalised tissue and remain moist and warm during the healing process, thus an excellent breeding ground for bacteria. In the early twentieth century, burns did not appear to respond to existing antiseptic methods. Many doctors believed that burns themselves released toxins and attempted to neutralise these by treating burns with dyes and acids, which often hindered recovery. As a result, many practitioners continued to regard the infection of burns as inevitable.

In the 1940s, important research in this field began to be undertaken in the English midlands at Birmingham Accident Hospital. When an existing general hospital on Bath Row in the city centre was moved to facilities behind the newly constructed Birmingham Medical School in 1938, the old site was renovated and reopened in 1941 as the Birmingham Accident Hospital. (Incidentally, the site was also the last voluntary (or charity) hospital established in England and Wales before the introduction of the National Health Service). The new hospital’s Surgeon-in-Chief and Clinical Director William Gissane (1898-1981) regarded this as an experiment in the care of trauma in order to improve local accident services, which were inadequate across the country. At the outbreak of the Second World War and the associated production of military hardware, this had become obvious; the incidence of local industrial injuries, including burns, increased by 40%. During 1943, a small unit to treat burns and scalds was opened, and Gissane invited Leonard Colebrook (1883-1967) to be its first Director. Like Gillies (see yesterday’s post), Colebrook was a veteran of the Great War and contributed to a Government-appointed war wounds sub-committee run by Archibald McIndoe during the Second World War. Colebrook had investigated the bacteriology of wounds at the burns unit at Glasgow Royal Infirmary, where he had previously investigated puerperal sepsis in maternity cases. He therefore had experience of both burns and streptococcal infections when called on by Gissane to run the Medical Research Council-funded unit.

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‘The Topical and the Local’

On arrival, Colebrook quickly turned to the investigation of streptococcus infections in burns. With new topical anti-microbial agents, such as penicillin and propamide, he and his team managed to reduce the prevalence of these infections to 5%. Controlling infection, whether through topical creams, or ventilated wards and bandaging stations, allowed for new burns treatments, such as early excision, which is still described as an important measure to prevent infection as well as disfiguring contractures. When he retired in 1948, Colebrook turned to organising local and national burns prevention campaigns, focusing, for example, on safer electrical heaters and the introduction of less flammable clothing for children.

Colebrook’s successor was Edward Lowbury (1913-2007), who became bacteriologist at what was later renamed the MRC Industrial Injuries and Burns Research Unit in 1952. Among other things, Lowbury initiated the first properly controlled clinical trials in burns, and infection rates continued their downward trend, until the emergence of antibiotic-resistant bacteria in the late-1950s. The introduction of silver nitrate in 1966 halted this rise, but rates would continue to fluctuate, as safer alternatives were introduced. By 1963, the burns unit had already become a large regional centre comprising 36 beds, a ‘clean air’ dressing station and expanding research facilities, with Lowbury compiling a unique record of resistance changes until his retirement in 1979. Treating over 18,000 burned patients between 1941 and 1993, the burns unit developed a planned, systematic approach to the treatment of these injuries, which greatly reduced the frequency of associated infections.

Problems of infection in hospitals in the wider Birmingham region led to the establishment of the Hospital Infection Research Laboratory in the grounds of Dudley Road Hospital (later City Hospital) in 1964. Administered by the MRC Burns Unit and under the direction of Lowbury, the laboratory assessed the number of infections in regional hospitals, determining causes when possible. Although the Accident Hospital closed its doors in 1993, the Infection Control Research Laboratory continues to exist in a new location. Many of its earlier recommendations for controlling infection are still in place today. With the laboratory celebrating its 50th anniversary this year, staff have organised a commemorative conference, and the History of Medicine Unit at the University of Birmingham has organised an exhibition on ‘the history of hospital infection’, which will be on display in the foyer of the Medical School until the summer.

Dr Jonathan Reinarz is Director of The History of Medicine Unit and a Reader in the History of Medicine at the University of Birmingham.

 
March, 2014

War burns and the birth of plastic surgery

Dr Jonathan Reinarz

The majority of historical research into burns has concentrated on the remarkable reconstructive work undertaken on burns casualties during the First and Second World War. In fact, some argue that plastic surgery as a specialty first emerged during the First World War. Soldiers in both wars sustained horrific injuries and dreadful deformities from high velocity missiles, explosives and burns, many of which would previously have defied repair. A young ear, nose and throat (ENT) surgeon from New Zealand, Harold Delf Gillies, began the war in a surgical unit at the Cambridge Hospital, Aldershot. Alarmed by the number of face and jaw reconstructions he was having to perform, Gillies visited two plastic surgeons in France before setting up a larger surgical unit in 1917 at Sidcup, where he brought together a team of specialists, including ENT colleagues and dental surgeons. Gillies is best remembered for the tubed pedicle, a flap of skin which was harvested from the arm or chest, for example, stitched into a tube, so as to retain a blood supply and gradually migrated to the area where it was required. By the end of the war, Gillies had developed many other surgical techniques and performed over 11,500 operations. Many of these are included in his best known publication, Plastic Surgery of the Face (1920), which, along with Gillies’s archives, has recently been digitised and made available online as part of activities to mark the centenary of the First World War.

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From Airman’s Burns to Hiroshima

In one of those accidents of history that historians have become used to over the years, many severe burns in the Second World War were placed in the hands of another young surgeon, Archibald McIndoe, who happened to be the cousin of Harold Gillies. Unlike most of the casualties seen by cousin Harold, McIndoe treated primarily flame injuries that largely resulted from a decision to relocate the petrol tanks of fighter aircraft in front of the cockpit and pilot. The consequences of placing 48 gallons of fuel in the nose of a Spitfire rapidly became apparent during the Battle of Britain in 1940, when burn casualties mounted and the medical community defined a new injury, ‘Airman’s Burn’. Nearly 400 Royal Air Force (RAF) crew sustained serious burns to their face and hands in 1940 alone, Richard Hillary becoming perhaps the best known due to his memoir, The Last Enemy, in which he described his injuries.

‘I looked at my watch: it was not there. Then for the first time I noticed how burnt my hands were: down to the wrists, the skin was dead white and hung in shreads: I felt faintly sick from the smell of burnt flesh.’

While the smell of burn victims and high fatality associated with serious burns had led many to be isolated, removed or even excluded from nineteenth-century hospital wards, Hilary was lucky to be treated in a specialist burns unit by one of only four plastic surgeons operating in Britain at this time (including Gillies who would spend his second war at Park Prewitt Hospital in Basingstoke). Appointed civilian consultant surgeon to the RAF, McIndoe became responsible for Hillary and many other air-force casualties at a surgical unit which was established in a cottage hospital in East Grinstead, 40 miles outside of London. Here, he treated hundreds of burned airmen and developed surgical techniques in order to improve on existing plastic surgery techniques, which often left much to be desired. According to Mcindoe, in these early years of reconstructive surgery ‘the end result seemed to convert the pathetic into the ridiculous’. Rarely satisfied with his first attempts, McIndoe worked 12-hour days and frequently subjected his patients to more than a dozen operations. He rapidly became recognised as the authority in the field, influential in developing new operations and discarding older treatments, such as the use of tannic acid to coat burns injuries. He hosted many visiting surgeons at East Grinstead, which had trained 60 surgeons by 1943, and secured his reputation in 1944 when 50 North American plastic surgeons attended his unit for ten days to train in preparation for the D-Day landings. He also increased the levels and training of nurses on his wards and introduced saline baths into burns treatment.

After the 1945 atom bomb attacks on Japan, the attention of doctors turned to the impact of modern warfare on both military and civilian casualties. McIndoe himself argued that burns would likely outnumber all other injuries in future wars. McIndoe’s colleagues similarly promoted such ideas, suggesting that ‘atomic flash’ burns necessitated whole hospitals be transformed into burns units, arguments reinforced in the aftermath of Hiroshima and Nagasaki and during the Cold War. Many more units like that at East Grinstead were established in the 1950s, and McIndoe continued to work in his 50-bed Burns Centre at East Grinstead until his retirement in 1959. In a lecture to the Royal College of Surgeons in 1958, he comprehensively outlined his views on reconstructive surgery and paid homage to ‘the greatest plastic surgeon of all times’, Harold Gillies. McIndoe died in 1960, aged 59. A statue is being planned to recognise his work; if realised this will be one of only three existing British public monuments in England commemorating surgeons.

Dr Jonathan Reinarz is Director of The History of Medicine Unit and a Reader in the History of Medicine at the University of Birmingham.

March, 2014

The imagery of burns

Dr Jonathan Reinarz

Burns are visually distinct and emotionally overwhelming. They are horrific and iconic. Think only of Thich Quang Duc, the Buddhist monk whose self-immolation was filmed and photographed in a carefully orchestrated protest against Vietnamese President Ngo Dinh Diem in 1963. Sitting in the lotus position, the elderly monk was doused with petrol by fellow monks before he set himself alight. The act, not surprisingly, ended in his death, but the events of 11 June 1963 also sparked a dramatic escalation in the conflict between Vietnam’s dictatorship, which favoured the country’s Catholic minority, and its Buddhist community. A description of the event by American journalist David Halberstam manages to add drama to the haunting photograph taken by Associated Press photographer Malcolm Browne by emphasising more than just visual spectacle.

‘Flames were coming from a human being; his body was slowly withering and shrivelling up, his head blackening and charring. In the air was the smell of burning flesh…Behind me I could hear the sobbing of the Vietnamese who were now gathering. I was too shocked to cry, too confused to take notes or ask questions, too bewildered to even think.’ (D. Halberstam, The Making of a Quagmire, 1965, 211) 

Sociologist Michael Biggs has argued that the power of this extreme form of protest comes from the likelihood that self-immolation will end in death (70% of cases are fatal). Hunger strikes may be averted, but in cases of self-immolation, death is not conditional. Not surprisingly, responses to such images are dramatic.

‘The Napalm Girl’

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Napalm

My second example captures another moment in the history of Vietnam (8 June 1972), nearly a decade after Guang Duc’s self-immolation. It was taken minutes after inhabitants of Trang Bang, a village north of Saigon, experienced a napalm strike, and it shows children running towards a wire roadblock on Route 1, the main highway between Saigon and Cambodia. As described in the first pages of Robert Neer’s recent history of napalm, earlier these children had been huddled with their families in a temple under the protection of South Vietnamese soldiers, when the building was mistaken for a North Vietnamese target. A group of injured and frightened children subsequently escaped the site and fled to a nearby checkpoint, where a waiting journalist noticed a naked nine-year-old girl who had been stripped by napalm, which continued to burn. It was then that Associated Press photographer Huynh Cong ‘Nick’ Ut captured his Pulitzer-Prize-winning photo. To many, it dramatically depicts the impact of war on non-combatants, and the day after it was taken, the photo appeared in newspapers alongside the heading ‘The Terror of War’. ‘Napalm Girl’ has become the best known image of the Vietnam War and is credited with bringing about a shift in the American public’s attitude towards the conflict.

Although burns have the potential to erase a person’s identity, by literally scorching away their features, the ‘Napalm Girl’ now has a name, Kim Phuc, and her story has been told in a film and a well-known biography. After capturing this pivotal image, Nick Ut took Kim and her brother to a South Vietnamese hospital. She subsequently spent 14 months in the Barsky Unit in the American hospital in Saigon. Kim’s burns, which covered 50% of her body, were grafted by American surgeons and, after two years of treatment and rehabilitation, she was able to return to her village. Like many burns victims, her life was fundamentally transformed, only, in this case, it was further altered by the particular political context. Forced to leave school, she was regularly interviewed and became a ‘national symbol of war’. Eventually defecting from Vietnam while en route to Cuba, she now lives in Toronto, Canada with her family. In 1997, she established the Kim Foundation International, a charity that assists child victims of war.

‘Mohamed Bouazizi’

As unique as Kim’s story may appear, many burns casualties have resisted remaining individual tragedies. Like the fiery death of Guang Duc, some have inspired imitators, or galvanised collective action. More recent cases of self-immolation have demonstrated this yet again, with the suicide of Tunisian fruit-vendor Mohamed Bouazizi recognised as a catalyst of the Tunisian Revolution, if not the wider uprising in the Arab world; in Panara and Wilson’s The Arab Spring (2013), he is the butterfly of chaos theory whose fluttering wings continue to cause storms around the globe. While burns units in the West continue to treat cases of self-immolation (two were admitted to the Birmingham Burns Unit over the Christmas holidays), many more patients, past and present, share similarities with Kim Phuc. As in the past, approximately 50% of burns victims are children. Their stories, like that of Kim, are also more often heard, not just in the popular press, but at burns conferences, such as that mentioned in yesterday’s posting, in order to better understand the experiences of patients.

Dr Jonathan Reinarz is Director of The History of Medicine Unit and a Reader in the History of Medicine at the University of Birmingham.

March, 2014

Burns: A riot in the body

Dr Jonathan Reinarz

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You can imagine, as a medical historian, much of my research centres on ‘Saving Humans’. When I was asked to contribute to this blog, though, one particularly timely subject immediately leapt out: burns. I began researching burns last year in the British context for the years 1800 to 2000, and, in that time, the public has been reminded of the subject with regular reports of acid attacks, house fires, wars, suicides and revolutions. More than many other subjects I have researched, burns are both timeless and very timely. In June 2013, the Burns Collective was launched in Birmingham, creating a national centre for burns research linking hospitals in London, Bristol and the ‘Second City’. I attended the inaugural conference and instantly found myself fascinated by papers outlining current practices, research and priorities. Though the history of burns remains to be explored, they should also be familiar to all of us. Unlike many diseases and accidents which will thankfully remain a mystery to most of this blog’s readers, we have all experienced burns. However prevalent or timely, burns are also particularly suited to a blog managed by the University’s Institute of Advanced Studies. Like the IAS, which aims to bring together scholars from across the University of Birmingham’s various academic disciplines, burns are unique in the way they bring together people from across medicine’s many specialties. 

In a previous project, I had the opportunity broadly to explore the medical, social and cultural history of the skin. At its most basic, a burn is an injury of the skin, the body’s largest organ (though some now call it a ‘multi-organ’). Addressing burns and scalds only in passing, the project reminded us that burns are prominent in the cultural imagination, and have been so for hundreds of years. Neither are they confined to the realm of the dermatologist. Besides contributing significantly to the way in which we conceive of ourselves and others, the skin has many essential functions: it regulates the passage of fluids in and out of the body; it helps synthesis vitamin D, while shielding the body’s interior from ultraviolet radiation; it is a barrier that prevents disease-causing organisms from entering the body, while simultaneously receiving sensations which it passes on to the brain via the nervous system. As a result, when the skin is burned, whether by hot tea, a sunburn, or following more serious flame, electrical or chemical accidents, we experience pain, and much else that is more than just skin deep. The skin’s many features and functions are invariably compromised by burns, and people’s identities may be changed forever. The more serious the burn – anything larger than 10% total body surface area is considered a major burn – the more violent the body’s response. It is for this reason that burns have been described as ‘a riot in the body’. All bodily systems potentially respond to serious burns, especially if the victim also experiences smoke inhalation.

What is a burn?

The immediate aftermath of a severe burn is shock and suffocation, both related to a lack of oxygen. Plasma normally circulating in the blood surges to the tissues, leaving the blood thicker and prone to clotting. During the 24-hours following a burn, the affected area grows progressively more swollen; this is the period when blisters form. Fluid must be replaced to restore circulation and dilute the toxins being expelled in greater amounts by the kidneys (one formula used to help calculate fluid replacement was developed by Basil Pruitt, who attended the Birmingham congress). In the nineteenth century, the oozing appearance of burns might have led doctors to introduce treatments which only encouraged dehydration. As a result of these physiological changes, the body is less able to regulate temperature and shock ensues. One by one, the major organs are compromised by the loss of liquids. When the respiratory system is effected, breathing becomes difficult and the body deals with lower cardiac output by pumping more blood. The additional effort required to do so sends the body into a hypermetabolic, or catabolic, state, and it begins to break down tissues, burning protein as well as fat. As body mass decreases, the patient becomes more susceptible to infection and wounds also heal more slowly. The destructive increase in metabolism, on the other hand, is countered by feeding the patient amounts of food that might ordinarily be regarded as excessive. And, importantly, the whole process is not over in a day or two. Burns are an acute illness that lasts weeks or even months. Treatment of burns patients therefore becomes an intensive life-saving process, which these days extends beyond the immediate survival of the burned individual, and aims for full psychological recovery, involving psychiatrists, physiotherapists and social workers, among many other specialists and professionals. It is for this reason that victims of severe burns are treated in burns units. According to the British Burns Association, there are currently 27 specialised burn units in Britain. In the 1930s, more than half of major burns cases in this country might have died from their injuries. Today, 97% of approximately 16,000 people hospitalised for burns each year survive this ordeal.

Dr Jonathan Reinarz is Director of The History of Medicine Unit and a Reader in the History of Medicine at the University of Birmingham.

 
February, 2014

World Government: Not Quite an Idea Whose Time has Come, but No Longer So Far from the Academic Mainstream

Dr Luis Cabrera

I can say without much reservation that I am one of the most avid students of world government alive today. Of course, I’m careful when and where I say that…

Actually, even in my relatively brief academic career (12 years, if you count from the PhD award date), there has been, if not a sea change, certainly a surprisingly strong trend toward serious academics taking the world government ideal seriously again.

Consider this: when my lead PhD supervisor and I were trying to put together a doctoral supervisory committee in the mid-1990s, we approached a staff member at the same US institution who had a solid global reputation as an international relations theorist. He was known for his cutting edge theorization of relations between nation-states. Yet, when approached about helping to supervise a thesis exploring the contemporary case for world government, he came back with a very rapid ‘no.’ It just wasn’t a topic he saw as meriting serious scholarly consideration, he said.

Now, such a response would likely be much harder to give. The past two authors to win the International Studies Association’s prestigious ‘Book of the Decade’ award, Alexander Wendt (2000) and Daniel Deudney (2010), have made world government enquiry a clear part of their work. Wendt, who is enormously influential for his work on how ideas and ideology can shape nation-states’ behaviour, has argued for the ‘inevitability’ of a world state – in 200 years or so. Deudney argues that the continuing threat from nuclear weapons remains so great that world-government creation is a necessity, though a weakly empowered one narrowly focused on weapons control.

Wendt and Deudney are only two of a range of IR scholars, economists, international sociologists and moral theorists who have recently explored the feasibility and desirability of full global political integration. Many others have taken up international institution building on a smaller scale, but still one that would require states to cede significant powers upward.

This might, in fact, be thought of as a second ‘heyday’ in world government thought. The first can be dated roughly from 1945-50. It was spurred by the US nuclear destruction of Hiroshima and Nagasaki, Japan, in August 1945. What had been unimaginable in war was suddenly cold reality. This prompted many to think that political realities must be reconceived as well.

This wasn’t  just a fringe few, either. Leading academics – including Albert Einstein – authors, jurists, political figures and civil society leaders around the world called for, or at least expressed openness to, a world government capable of meeting the awful new threat.

The following quotation from Birmingham-area MP Henry Usborne gives a sense of the urgent rhetoric of the time. In his maiden speech to Parliament in 1946, Usborne outlined a plan for Britain to lead the way to a security and political union with like-minded democratic countries that could evolve into full world government:

‘I imagine that this proposal would meet with a great deal of opposition. That I do not mind. I am quite certain that if we doubled the opposition we should get 10 times the enthusiasm from the common people all over the world in support of a proposal such as that. Is the proposal fantastic? Is it Utopian? Yes, it is both fantastic and Utopian. It is just as fantastic as the atomic age in which we now live; it is just as Utopian as the hope of world peace.’

They ‘heyday’ period ended almost as quickly as it had begun, with the advent of the Cold War and fears of Soviet global domination.  Though some academics and others continued to make the case for world government, they remained mostly on the fringes for about the next 50 years.

Today’s resurgence of academic literature on world government, spurred in part by globalization, is distinguished by the range of disciplines involved and the prominence of some of those involved. Their arguments tend to fall into three camps. In the first, authors such as Deudney highlight continuing threats from world government, as well as terrorism and other security issues, as reason to pursue comprehensive forms of integration between nation-states.

The second camp is concerned with democratic rule. Here, ‘cosmopolitan democrats’ argue that, in an age of intensifying globalization and global economic integration, domestic democracies are losing their powers to live under laws of their own making. Thus, democratic decision making should be shifted upward, generally to include all of those who are affected by specific processes of globalization, or by the decisions of global bodies such as the World Trade Organization. Few of these authors would claim the world government title for their work, but several do advocate the creation of powerful, binding global institutions with broad powers to tax and spend for the common good.

A final camp is concerned with the promotion of justice and human rights globally. Here, authors argue that state sovereignty throws up predictable barriers to actually realizing justice or securing the rights of all persons, so forms of integration should be pursued between states. My own work would be situated here. I have argued in a couple of books and several articles that the current global system will routinely underfulfill individual rights: http://www.birmingham.ac.uk/staff/profiles/government-society/cabrera-luis.aspx That’s because it leaves states as the final judges in their own cases about obligations. Imagine if we were all left to judge which rules or laws we would prefer to follow, or especially how much tax we’d like to pay. We’d mean well, but chances are we would see other priorities repeatedly getting in the way of ‘donating’ the tax voluntarily that would be needed to maintain social institutions.

Like most students of world government, I take a very long term view. If it ever will be possible to create global institutions capable of routinely protecting the rights of all persons, I have suggested, we shouldn’t expect to see them develop for many hundreds of years. My recent work has been concerned with the kinds of integration and related changes that might be possible in the near term, and yet would conceivably contribute to the long-term aim. I have considered in particular some potentially rights-enhancing forms of regional integration.

I have enjoyed being able, as this week’s Saving Humans ‘guest blogger’ to share some thoughts on recent developments in democracy and human rights. To recap: on Monday, I discussed a new organization, Academics Stand Against poverty, that is dedicated to strengthening the academic voice and direct positive impact on poverty issues globally. On Tuesday, I discussed my own work on global citizenship and immigration, with emphasis on field research among unauthorized immigrants, and with anti-immigration and migrant-rights activists.

On Wednesday, I talked about current work on human rights and prospects for, or possible reasons to purse, trans-state democracy. I looked there at how India’s National Campaign for Dalit Human Rights had sought to reach out to the global human rights community to bring pressure on its own government to do more against caste-discrimination. Thursday’s entry drew connections between the theoretical concerns there and in the struggle by opposition leaders and activists in Turkey to maintain a free, open democracy, against the backdrop of possible accession to the European Union. Today’s entry took the much longer view on rights and integration.

Luis Cabrera is Reader in Political Theory, Department of Political Science and International Studies, University of Birmingham.

February, 2014

Democracy, Rights and European Hopes in Turkey

Dr Luis Cabrera

Yesterday I wrote about the importance of individuals being able to both chasten and challenge political leaders. Constitutionalized liberal democracy, I suggested, is valuable primarily – though not solely – as a means of doing this. The right to vote in regular elections, along with rights to assembly, speech, protest, and closely related rights to bring formal challenges in courts, all are means of holding those who govern us to account.

Today I want to shift the focus from India and the Dalit (former untouchables) human rights struggle to Turkey. The two may not be obvious cases to treat in the same book or blog series, but in fact, some important issues intersect in both. In the Dalit human rights case, activists struggling on behalf of a category of persons within a country assert that those persons’ rights are being systematically violated. They believe that India’s democratic institutions and courts remain stacked against Dalits, despite anti-discrimination laws on the books. At the same time, the Indian government strongly resists ‘outside interference,’ or outreach by such activists to global human rights actors. It reserves the right to interpret rights standards and rights fulfilment to itself.

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Protestor, Turkey, July 2013

In the Turkish case, similar claims are heard about democratic institutions and leaders who are increasingly unresponsive to opposition voices. Turkey has long been noted as a secular country, observing strict separation between state and Islam, the religion ascribed to an overwhelming majority of its population. One of the consistent complaints from opposition and activist leaders has been that Prime Minister Recep Tayyip Erdogan (pronounced ER-doh-WAN) has been incrementally introducing religious values and behavioural restrictions into law. Activists also complain of a creeping authoritarianism, on which more below.

The Turkish case, like the Indian one, has a significant international, or supranational, angle. Where the Dalit human rights activists have sought to reach out to the global human rights community in the absence of anything like a Global Court of Human Rights, Turkey has long held hopes of joining the still-expanding regional governance project just beyond its own borders.

For me, the Turkish case has been of great interest for the ethical questions it raises about obligations across borders. My basic presumption has been that Turkey stands to receive the same human rights benefits as other less-rich countries had on joining the European Union in the last several decades. These would include particularly Spain, Ireland, Portugal and Greece. Spain and Portugal were not only relatively poor countries at the time of accession, but they also faced steep challenges to democratization and democratic consolidation. Many observers see European Community membership as an important factor helping them develop stable, rights-respecting democratic institutions.

Of course, few would suggest that membership in the now-European Union is a cure for all political ills, or that the EU itself has developed into a fully defensible set of democratic institutions. EU leaders are still dealing with the fallout from the global economic crisis, which revealed some cracks in institutional design that may need more than a quick plaster-over. Yet, longtime EU observers will note that this is far from the first crisis, and that in fact the EU’s demise has been predicted many times.

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Istanbul Police lined up, July 2013

In relation to Turkish accession, my presumption remains that it would deliver significant additional rights benefits to Turks. It would further integrate the country into the EU common market, give it a much stronger political voice in helping to shape and set the direction for that market, while enhancing economic opportunities for individual Turks, not least free movement across borders. It also should help to better ensure robust democratic rights.

I went to Istanbul for the first time last summer, to interview government officials, activists and think-tank representatives about prospects for Turkish accession. Full accession for Turkey has long been a controversial issue in some EU states, of course. This is because first, important issues remain unresolved around EU member state Cyprus. Turkey holds half of Cyprus’ territory in circumstances that continue to draw protest from several quarters. Turkey also would become the second largest EU country, behind Germany, giving it instant political clout in the union. And, a factor which is generally whispered about except by far-right factions, which tend to shout about it, Turkey would be the first Muslim-majority country in the EU. Even so, there is significant support for Turkish accession within the EU, along with opposition, notably within Germany and France.

When I arrived in Istanbul, after an earlier trip to Brussels to interview Turkish and EU officials, I found that few had EU accession foremost in their mind. Rather, they were focused on the flashpoint of Gezi Park. That park – an urban oasis in a city notably lacking in greenery – had become the focal point for demonstrations against the Erdogan regime, stemming from plans to let developers raze it for a shopping plaza.

I took a hotel near the park, which had been cleared of activists not long before in a police crackdown which saw three protesters and one police officer killed. The government response brought harsh criticism from the European Parliament. That was rejected by Erdogan, who questioned the Parliament’s legitimacy and blamed the protests on outside influences.

I spent several days interviewing leaders of activist groups that were focused on democratic governance, with emphasis on those which also interacted with EU institutions, as well as some political party and policy officials. On two nights, I joined the protesters who still filled the streets of the posh shopping district near Gezi Park. In interviews, they expressed their anger at what they saw as authoritarianism and religiosity gradually but relentlessly taking over their political institutions. Few mentioned the EU without prompting. Support for accession in polls of Turks has steadily dropped in recent years, as frustration has grown over the slow pace of accession talks – even while Croatia, which was given permission to move toward full membership at the same time as Turkey, was admitted. Yet, when asked, most saw EU membership as providing additional resources to challenge the government.

After a few dozen interviews, and being water cannoned and tear gassed by police, I decided I had collected enough from the protesters themselves (!) I did, however, join them another night, after they had quietly walked back into Gezi Park, police standing by, and turned it again into a site for singing, chanting, and expression of views.

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Protestors filling Istiklal St., July 2013

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Woman in goggles, July 2013

Now, six months later, EU leaders are again laying charges of authoritarianism, this time in response to a stringent law pressed by the Erdogan government on internet usage. Critics charge that the law amounts to bald censorship. At the same time, there were hopes for progress on EU accession talks, after years of virtual standstill. The struggle to shape the country’s democracy undoubtedly will continue, though it remains to be seen whether it will be conducted more firmly in the EU context.

Police and billboards, Turkey, July 2013

Police and billboards, Turkey, July 2013

Luis Cabrera is Reader in Political Theory, Department of Political Science and International Studies, University of Birmingham.

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