Friday, September 30, 2016

Grand Central Station: 10 Million Oysters!!!

©2013 Am Ang Zhang

©2013 Am Ang Zhang
22 million visitors a year.

10 million oysters a year at Grand Central Oyster Bar.

Other book I am reading:

The gene is, and is not, the determiner of our identity. It behooves us to accept this paradox and understand it. As we learn how our genome defines us, we also learn how we transcend our genome.

Thursday, September 29, 2016

National Coffee Day: Panama Fakes and Failures!

Panama has been associated with some fabricated plots. There were the John Le Carre book The Tailor of Panama that was turned into a film, the location shoot of the Quantum of Solace (in Panama, doubling as a country in South America), and the Canoeist faking death, just to mention a few.

Then there was the coffee scandal.
In 1996 in California, a certain  Michel Norton, owner of Kona Kai Coffee was sentenced to 30 months in prison. Apparently for an extended period of time (some reckoned a decade may not be an over estimate), cheaper and “lower grade” Panamanian and Costa Rican coffee were used to pass off as “Pure Kona Coffee”.

Cheaper, certainly, as you would not otherwise be doing it. But, INFERIOR? I think many would certainly dispute that. I do not think you can really use an inferior product to pass off as something superior and fool people for long.

 ©2012 Am Ang Zhang

So the Ambassador of Panama in Washington D.C. wrote to the 
New York Times:

To the Editor:
I read with amusement about the indictment of a coffee supplier on selling fraudulently marked beans to retailers (news article, Nov. 13).
Without making light of the charges, I am pleased that the coffee buyer for Peet's Coffee and Tea is uncertain that he can tell the difference between the ''cheaper'' Panamanian beans allegedly substituted for the more expensive Kona.
Panama's coffee is among the world's best. In fact, members of my staff have seen Panamanian beans for sale at high-end coffeehouses for little less than Kona. Perhaps we can arrange a taste test of Kona and Panamanian coffee for the sellers mentioned in the article. I am sure that no one will be more pleased with the results than my native coffee growers. 

Ambassador of Panama, Washington

The Cockroach Catcher was fortunate enough to have visited both Costa Rica and Panama. Costa Rica coffee is quite well known but few people realise that Panama produces coffee. I was determined to find out more about coffee grown in Panama.

Plants need to struggle to produce the kind of ‘poison’ against diseases, and coffee apparently is no different. This is well known for wine: vines grown in abundant sunshine may produce wine with a high alcohol content but does not produce enough of the ‘poison’ that humans love — we call the ‘poison’----- anti-oxidants.

Now even for the wonder malaria drug, Artemisinin, the plant Artemisia annua if cultivated with good fertilisers will not produce the anti-malaria ingredient at all.

Yes, plants need to struggle. Shade, and a misty atmosphere all work together to help the coffee shrubs struggle and help certain varieties of to develop health conferring properties, although the yield is lower than if you apply fertilisers and cut away the shading trees. 

David Cameron & The NHS: Politician & The Panama Canal

It is a common practice for politicians to ignore professional advice. As The Cockroach Catcher, his wife and friends cruise across this greatest of all human endeavour, he likes to re-post one of the Panama Posts.Sometimes they might get away with it; sometimes it led to failure, gross failure as in the case of the French attempt at building the Panama Canal.Can we really learn anything from such a colossal failure.

Panama Canal © 2008 Am Ang Zhang

Most people probably know about the French failure to build the Panama Canal. Many thought that this was due to yellow fever and malaria which were diseases thought to be due to some toxic fume from exposed soil.

Extracted from the Official Website: Panama Canal Authority /French Construction

In 1879, Ferdinand Marie de Lesseps, with the success he had with the construction of the Suez Canal in Egypt just ten years earlier, proposed a sea level canal through Panama. He was no engineer but a career politician and he rejected outright what the chief engineer for the French Department of Bridges and Highways, Baron Godin de Lépinay proposed, a lock canal.

The engineer was no match for a career politician:

“There was no question that a sea level canal was the correct type of canal to build and no question at all that Panama was the best and only place to build it. Any problems – and, of course, there would be some - would resolve themselves, as they had at Suez.”

“The resolution passed with 74 in favour and 8 opposed. The ‘no’ votes included de Lépinay and Alexandre Gustave Eiffel. Thirty-eight Committee members were absent and 16, including Ammen and Menocal, abstained. The predominantly French ‘yea’ votes did not include any of the five delegates from the French Society of Engineers. Of the 74 voting in favor, only 19 were engineers and of those, only one, Pedro Sosa of Panama, had ever been in Central America.”

The French failed in a spectacular fashion.

Cost to the French: $287 Million (1893 dollars) or $6.8 Billion (2007 dollars)

Many reasons can be stated for the French failure, but it seems clear that the principal reason was de Lesseps’ stubbornness in insisting on and sticking to the sea level plan.  But others were at fault also for not opposing him, arguing with him and encouraging him to change his mind.  His own charisma turned out to be his enemy.  People believed in him beyond reason.

Could any of us learn anything from this experience?

Hermione: "You pay a great deal too dear for what's given freely". -

(Act I, Scene I). The Winter’s Tale.

Oct 16, 2010 ... Myrtilles Sauvage & Geisha Coffee. Years ago we spent a late autumn holiday in the French Alps. It was a wonderful time to be going on hikes ...

May 22, 2013 ... My friend's coffee plantation provides a beautiful setting for photography. The trees provide good shade for good coffee growing. 

Tuesday, September 27, 2016

Finland & Suicide: Settled Medical Science!

Medicine progresses and new discoveries are made though not necessary all that often. Compare with transistor and electronic technology medicine is the tortoise.

Yet, there are things we thought were a given at Medical School. Certainly, functions of well known Vitamins such as A, D & C. Vaccination against Smallpox. Endocrine conditions such as Thyrotoxicosis and Type 1 Diabetes. Stress and Peptic Ulcer is more or less a given. This is the phenomenon of “settled medical science”, next topic please.

We have at our school a wonderful teacher in endocrinology. Coming to think of it, a great one in haematology, GI disorders and I am not even venturing out to other specialties. Of course all our teachers were British trained and many became really the parents of medicine in Hong Kong.

We were so proud of our teachers that we have acquired a degree of arrogance about certain areas of medicine. We certainly know all there is to know about Thyroid, Diabetes and Thalassaemia. Peptic Ulcer is an interesting one as our Professor, Old Mac is not happy and decided that we should only call it Ulcer Syndrome, and as with other syndrome diagnosis, it implies that we still do not know. It has taken nearly another three decades before someone else proved that he was right.

 September 2012 ©2012 Am Ang Zhang

So in 1996, I was in Finland for a World Congress in Infant Psychiatry more or less during the longest daylight week of the whole year. Walking back with some Finnish Child Psychiatrists back to our University Accommodation at well past 11 at night when it was still bright, my Finnish colleagues jokingly said that in Finland, people started contemplating suicide after the Summer Solstice.

That Finland has the highest suicide rate of any first world country is well known and ever since the popularity of the diagnosis of SAD, it was naturally assumed that darkness in the Finnish Winter must have contributed to their famous suicide rate. I was back to Finland in 2012, this time for an extended Autumn holiday. Researching before travel uncovered some medical information that surprised me.

Extensive research in Finland[1] revealed that the highest rates of suicide started in May peaking at Summer solstice and tailing off symmetrically in July.

Our key finding of statistical significance demonstrates the increased suicide mortality on nationwide level in Finland during the period from May 14th to July 25th. This 76-day period covers symmetrically both sides of summer solstice. During this period there is only 1 to 4 hours of darkness during the night in Helsinki but no darkness at all in Oulu.

This is a high quality research that came out in 2011 in a country where suicide rate is high although in recent years, they have done much in terms of improving mental health care that has quite dramatically moved Finland out of the top few countries.

As I have stated earlier, there are subjects we studied in medical school and had the confident impression that our knowledge on some conditions were complete! Now let us concentrate on other newer conditions. Settled Medical Science indeed.

Feb 19, 2013 ... Adult A.D.H.D. & Faking: Real Psychosis & Suicide. Adult A.D.H.D. is open to faking and more so by medical students. In children, it was my ...

Jun 6, 2013 ... Stephen Fry has disclosed that he attempted suicide last year and only survived the “close run thing” when a colleague found him unconscious ...


Monday, September 26, 2016


Those of you who managed to catch the first Chapter "The Seven Minute Cure" will be wondering: Is the Cockroach Catcher famous as Barbados is for the British Celebrities? Some even arrives by Concorde!  Used to anyway!

Well, let the truth be told, Am Ang discovered Barbados long before the celebs.  He is still very fond of it though he tends to visit when the celebs have left and he can have the beaches to himself. His favourite beach is Accra Beach

There he has seen hatching turtles marching into the ocean, the few that remains of course.

In Barbados, the Cockroach Catcher also picked up golf, the only addiction where there is no cure, no rehab. None required anyway. 

There too he rediscovered his childhood love of snorkeling and he later marveled (in his book of course) at the way mankind took the better part of two decades to come up with a new snorkel design and lamented the sluggishness of medical progress.

Barbados is also the place that has the second highest number of centenarians per capita. Is it the fish they eat, the slower place of life or is it something that we have come to avoid, sunshine?

In the end genetics probably prevail; but one cannot let what is written in one's genes dictate one's life.

“There are two futures,
the future of desire and the future of fate,
and man's reason
 has never learnt to separate them.”

J. D. Bernal

The Cockroach Catcher    Chapter 3   Barbados and Retirement

Barbados, as everyone knows, is an island in the Caribbean. We had never taken a holiday in the Caribbean and it was a shock to friends and colleagues when news broke that we were moving there. 
      It may seem ironic given my love for my work that I could give it up so easily. The truth is that the unrelenting re-organisation after re-organisation in the NHS had finally taken its toll. I first arrived on this tropical island to accompany my wife to take up a two year posting with her employer less than a week after September 11. We had no idea where the world was heading and if there was going to be any world conflict Barbados seemed to be far enough away from where those conflicts might be. We first stayed in a hotel right by the sea on one of the loveliest beaches in Barbados that to this day remains our favourite. 
      We arrived in the evening, and in Barbados when the sun goes down it becomes pitch black immediately.  Imagine the surprise in the morning when I pushed open the door to the small balcony overlooking the beach and saw the loveliest blue sea that only the white coral sand and Caribbean September sky could conspire to provide.  Pure white coral sand tinged with pink and beckoning palm trees complete with gentle surfs was a sight too much to resist.

      There is a Buddhist saying:  Better save one life than build a seven-storey pagoda.  I felt that I had done my duty as a doctor, and could now retire and let the younger generation take over. It would be dishonest of me not to mention my frustration with recent changes in the NHS – no, not changes for the better.  The havoc on my physical health together with events of September 11 were the final straw.
      I remember bumping into one of the neurologists who retired a year earlier from my hospital. We more or less started at the hospital around the same time and most years we managed to meet up at Glyndebourne.
      Glyndebourne is one of those places that started life as a private opera house. The small and intimate opera house proved too small and eventually a new opera house with much bigger capacity was built in its place. Fortunately the gardens were left relatively intact and every year from late spring to late summer operas are performed every evening with an extended interval so that patrons can have a nice champagne picnic in the grounds. Most patrons continue with the Black Tie tradition and the few dissenters just look out of place. It was during one of the dinner intervals as I was ready to open a bottle of champagne when I saw the neurologist. When he learnt that I too was contemplating retirement, he exclaimed, “There is a hell of a lot of life after the NHS, you know.”
      It was not necessary for him to have said anything as my mind was already made up. On a sunny afternoon in the beautiful setting of Sussex countryside cows grazed on the other side of the ha-ha.  How many hours do they have to graze in order to produce a pint of milk for the coffee that we nicely dressed humans consume? Is there a lesson there somewhere?
      It is not that difficult to decide that there is more to it than to continue to toil under politicians all purporting to do their absolute best. We all started off with high hopes. Hope for a better health service. Hope for humanity and mankind.
      As my first guru and mentor in England put it when I called him with the news of my consultant appointment, “You now only have your retirement to look forward to.”  How right he was.

The Cockroach Catcher on Amazon Kindle UKAmazon Kindle US

Sunday, September 25, 2016

NHS: Best Health Care!

Friends moved to France after their retirement and lived in one of the wine growing districts.
 ©2008 Am Ang Zhang
They were extremely pleased with the Health Care they received from their doctor locally. After all, not long ago, French Health Care topped the WHO ranking.

Then our lady friend had some gynaecological condition. She consulted the local doctor who referred her to the regional hospital: a beautiful new hospital with the best in modern equipment. In no time, arrangement was made for her to be admitted and a key-hole procedure performed. The French government paid for 70% and the rest was covered by insurance they took out.

They were thrilled.

We did not see them for a while and then they came to visit us in one of our holiday places in a warm country.

They have moved back to England.

What happened?

Four months after the operation they were back visiting family in England. She was constipated and then developed severe abdominal pain. She was in London so went to A & E (ER) at one of the major teaching hospitals.

“I was seen by a young doctor, a lady doctor who took a detail history and examined me. I thought I was going to be given some laxative, pain killer and sent home.”

“No, she called her consultant and I was admitted straight away.”

To cut the long story short, she had acute abdomen due to gangrenous colon from the previous procedure.

She was saved but she has lost a section of her intestine.

They sold their place in the beautiful wine region and moved back to England.

The best health care in the world. 

Now we know.

Let us keep it that way.

NHS & Private Medicine: Best Health Care & Porsche

Do we judge how good a doctor is by the car he drives? I remember medical school friends preferred to seek advice from Ferrari driving surgeons than from Rover driving psychiatrists.

My friend was amazed that I gave up Private Health Care when my wife retired.

“I know you worked for the NHS but there is no guarantee, is there?”

Well, in life you do have to believe in something. The truth is simpler in that after five years from her retirement, the co-payment is 90%.

He worked for one of the major utility companies and had the top-notch coverage.

“The laser treatment for my cataract was amazing and the surgeon drives a Porsche 911.”

Porsche official Website

He was very happy with the results.

“He has to be good, he drives a Porsche.”

Then he started feeling dizzy and having some strange noise problems in one of his ears.

“I saw a wonderful ENT specialist within a week at the same private hospital whereas I would have to wait much longer in the NHS.”

What could one say! We are losing the funny game.

What does he drive?

A Carrera.

Another Porsche.

We are OK then.

Or are we.

He was not any better. And after eight months of fortnightly appointments, the Carrera doctor suggested a mastoidectomy.

Perhaps you should get a second opinion from an NHS consultant. Perhaps see a neurologist.

“I could not believe you said that, his two children are doctors. And he has private health care!” I was told off by my wife.

He took my advice though and he got an appointment within two weeks at one of the famous neurological units at a teaching hospital.

To cut the long story short, he has DAVF.

I asked my ENT colleague if it was difficult to diagnose DAVF.

“Not these days!”

He had a range of treatments and is now much better.

All in the NHS hospital.

“I don’t know what car he drives, but he is good. One of the procedures took 6 hours.”

Best health care.

I always knew: Porsche or otherwise.

Best Health Care: NHS GP & NHS Specialist

Does having a good hunch make you a good doctor or are we all so tick-box trained that we have lost that art. Why is it then that House MD is so popular when the story line is around the “hunch” of Doctor House?

Fortunately for my friend, her GP (family physician) has managed to keep that ability.

My friend was blessed with good health all her life.  She seldom sees her GP so just before last Christmas she turned up because she has been having this funny headache that the usual OTC pain killers would not shift.

She would not have gone to the doctor except the extended family was going on a skiing holiday.

She managed to get to the surgery before they close. The receptionist told her that the doctor was about to leave. She was about to get an appointment for after Christmas when her doctor came out and was surprised to see my friend.

I have always told my juniors to be on the look out for situations like this. Life is strange. Such last minute situations always seem to bring in surprises. One should always be on the look out for what patient reveal to you as a “perhaps it is not important”.

Also any patient that you have not seen for a long time deserves a thorough examination.

She was seen immediately.

So no quick prescription of a stronger pain killer and no “have a nice holiday” then.

She took a careful history and did a quick examination including a thorough neurological examination.


Then something strange happened. Looking back now, I did wonder if she had spent sometime at a Neurological Unit.

She asked my friend to count backwards from 100.

My friend could not manage at 67.

She was admitted to a regional neurological unit. A scan showed that she had a left parietal glioma. She still remembered being seen by the neurosurgeon after her scan at 11 at night:

“We are taking it out in the morning!”

The skiing was cancelled but what a story.

Best GP

Best Specialist


Thursday, September 22, 2016

Tea Plantation: BOH Malaysia.

All Photos ©2016 Am Ang Zhang

BOH Plantations was founded in 1929 by J.A. Russel, a British businessman during the British colonial era in Malaya. He was optimistic of the tea plantation business due to huge demands despite of the world-wide Great Depression at that time. As a result of the potential, he applied for and was granted a concession of land for his first tea garden in Habu, Cameron Highlands.