"You Can Choose Light and Choose Life"

"Then they shot at us. The car lost control, flipped over and  stopped. The doors were locked. We realized we couldn't get out, so we got out from the windows. The moment I landed on the ground, I was shot at point blank range."

"What good are your [United Nations] resolutions, your debates, your empty promises, if the sick, elderly, mothers and their children are left to rot in the terror tunnels?"

Israeli Hamas hostage Mia Schem

Chaim Otmazgin, one of the first ZAKA volunteers to arrive at the scene of the Nova massacre, forces himself to share the horrific stories because he ‘promised the bodies’ he would be their mouthpiece. Lisa Hostein; Photos of those who were murdered or abducted dot the landscape of the Nova music festival site. Yael Ilan

 

At the Nova Music Festival in Southern Israel on October 7, 2023, then-21-year-old Mia Schem, along with her friend Elia Toledano fled when "red alert" sirens sounded, with rockets from Gaza flying overhead. Twenty minutes driving away from the festival location failed to bring them to safety. When Mia Schem was shot as she emerged from the toppled car, she realized that pieces of her right hand were "flying into the air". She was was in the presence of burning cars, scattered bodies of the young festival-goers.

 

She made a split-second decision, her survival instinct directing her to "walk toward the terrorists", reasoning that to do so, might be her only chance of survival. "I was dragged by my hair into a truck with seven Hamas monsters", she recalled. Held captive initially in a private home in Gaza, she was later transferred to the Hamas' infamous tunnel system. There, she was placed in a small cage: "They treated me like an animal. They didn't give me any medicine, any treatment, nothing".

 

 A grab from a UGC video posted on Telegram on October 9, 2023, shows an armed Palestinian terrorist walking around the Supernova music festival, with a body behind him, near Kibbutz Re’im in the Negev desert in southern Israel (ANONYMOUS / AFP)

 

Held in this manner for 55 days, she was eventually released on November 30, 2023. The body of her friend, Elia Toledano, was returned to Israel several months later. A year afterward, while around a hundred hostages remained in captivity in Gaza, she addressed the United Nations Security Council, where she informed them that the Nova Festival was "a bloodbath". There, "hundreds of young men and women were shot, dismembered, raped and kidnapped".   

"I choose gratitude. Gratitude for the simple things. For waking up every morning. For breathing."

"For being able to hug my family. To be with my family."

"The most important thing I want people to understand is captivity didn't end the day I came home. My body came back, but part of my heart and soul is still there."
"Every day I make the choice to get  up and keep going, to live. I don't want people to remember me only as a hostage."

"I want them to remember me as a woman who chose life after everything I went through."

Mia Schem 

Screen capture from video of Hamas terrorist Muhammad Abu Aseed celebrates as he abducts IDF soldier Naama Levy on October 7, 2023.

 

During the time of her seemingly endless loss of normalcy, hope never left her tormented mind. She strove to be herself, to believe in herself, and to believe in others, and that some day she would be released, she would be reunited with her family, and she would go on to live her life, forever altered as it would be. In her dank, airless captivity, caged and incapable of normal movement, she turned to daily singing of Shir Lamaalot (A Song of Ascents), for comfort and to remind herself that she would surmount the trauma of what she had borne and witnessed.   

"I hope people understand what my story is. That my story is not only an Israeli story or Jewish story. It is a human story."

"Terrorism doesn't choose a religion and nationality, or skin colour. When we stay silent in the face of hatred and violence, everyone loses."

"I hope people will choose the trust, choose compassion, and the courage to stand with innocent people, and most of all, I want them to remember that there is always hope, even in the  darkest place."

"You can choose light and choose life." 

Mia Schem  

Screams Before Silence, October 7

 

Ancestral Knowledge Rising to the Occasion

"First of all, the wish to maintain their lives.The second one, they are Indigenous people, so they have immunity to so many hazards inside the jungle. And third one, they know the jungle."

"[The children's background meant they knew] how to survive in the jungle, how to eat, how to drink, stay against the hostile jungle and how to protect from the rain, because 16 hours a day it’s only rain."

"The minors were already very weak. And surely their strength was only enough to breathe or reach a small fruit to feed themselves or drink a drop of water in the jungle." 

"This wasn't a search for a needle in a haystack, it was a tiny flea in a vast carpet, because they kept moving."

Gen. Pedro Sanchez, search leader, Colombian military

 

"Finding enough high-quality food, building shelters and keeping away from harm’s way for 40 days and nights in a remote area of the Colombian Amazon would challenge most adult Westerners ... never mind three children younger than 13 carrying an 11-month old baby."

"Some 100 years ago, that body of knowledge was very vigorous, but there were no aircraft one could crash in the jungle; 100 years into the future, there may be even more efficient aircraft but very little of that knowledge will be left."

Carlos Peres, University of East Anglia, England

The four children were discovered in the Solano jungle Friday. Colombian Armed Forces Press Office / via AP

"[The children were lost] in a very dark, very dense jungle, where the largest trees in the region are."

"The same mother, who became a spirit after the [plane crash] accident, protected them."

"And only now is she going to start resting."

Indigenous expert Alex Rufino

Colombians were magnetically, emotionally glued to their news services, hoping for over a month to hear that four young children survived the unbelievable ordeal of being in a plane crash in the heart of the Colombian jungle. The Cessna 206 aircraft carrying them with their mother, had crashed on May 1st into the Amazon, killing their mother, the pilot and an Indigenous leader.

The children, aged 13, nine, four and 11 months were on their own. After they were found, the oldest child, Lesley, informed their rescuers that their mother had lived for four days beyond the crash. And that before she died, she instructed her children to leave the crash site, to search for help. These vulnerable children were left to fend for themselves "in an area teeming with snakes, jaguars and mosquitoes", in the words of news media.

But these were Indigenous children, accustomed to hearing about and learning about nature and survival. Lesley had knowledge of which fruits in the wild were to be eaten safely, and which to avoid. She was capable of looking after an infant. Her grandmother is an Indigenous elder, and the family often played "survival" games. This is the background exposure that helped this 13-year-old girl to guide her younger siblings to survival.

 

Members of the Colombian army check one of the four Indigenous children Friday.  Colombian Air Force / AFP - Getty Images

On Friday, fully 40 days following the light plane crash that sent them nose-first into dense Amazon jungle, coming face-to-face finally with their rescuers, Lesley's first words, as she encountered the relieved men while carrying her infant brother were "I'm hungry". She was, without doubt, beyond hungry, the children were almost skeletal, weak and likely verging on the physical inability to continue carrying on, on their own.

The searchers came across clues informing them that the children were there, in the vast green confines of the jungle, still alive they hoped, when they discovered fruit seemingly with human tooth marks, footprints, a baby bottle, diapers, and the loyal services of a trained rescue dog who led rescuers eventually to the lost children. There were several hundred volunteers from local Indigenous groups in the search party comprised of 150 military troops.

They had gone through an area of over 30 square kilometres in their frantic search, hoping to give good news to a nation gripped in fear and suspense. When the children were found, one of Magdalena Mucutuy's sons told the rescuers: "My mum is dead", as he rose from where he was found, resting on the ground. The children were taken to a military hospital in Bogota to be treated for malnutrition. Their recovery and removal aided by being winched out of the jungle and helicoptered to hospital.

 

Army radios crackled "miracle, miracle, miracle, miracle", code that all four were found alive, on Friday evening. The children are members of the Huitoto Indigenous group who are taught to hunt, to fish and to gather the fruits of the earth from an early age. A bag of cassava flour had been on the plane, that the children ate while searching for help, along with seeds and avocado-like fruits from the
Bacaba palm tree, rich in oil. 

The Colombian military had dropped ten thousand leaflets printed in Spanish and the Huitoto script, with survival tips. Boxes of food were also dropped in hopes the children might come across them. Broadcast messages from helicopters flying over the area, from the children's grandmother, reassured them that rescue teams were searching for them. 

There was constant exposure to heavy rainstorms, and there was speculation of armed groups active in the jungle. The children had erected a small shelter from a tarpaulin. "They always stayed near the river, and she (Lesley) carried a small soda bottle which she used to (fill with and) carry water", an Indigenous man among the search team that found the children explained. Indigenous experts feel the  children's survival is accounted for as a result of their ancestral knowledge, their "spiritual connection with nature".

It was in fact, a rescue dog that found the children; Wilson, a six-year-old Belgian Shepherd who had tracked the four siblings after running away from his handlers. The dog stayed with the children for several days, then unaccountably moved off and was again lost. It was his tracks that helped to lead the search parties to the children. Now that the children have been found, the search for Wilson's whereabouts continues.

 

Wilson the Belgian shepherd who took part in the rescue operation.   AFP - Getty Images

 

Why . The . Mystery?

"After arduous searching by our military, we have found alive the four children who went missing after a plane crash in Guaviare. A joy for the country."

"I have decided to delete the tweet because the information provided by [the government’s child welfare agency, ICBF] could not be confirmed. I apologize for the confusion."

"The Military Forces and the indigenous communities will continue in their tireless search to give the country the news it is waiting for."

"At this time there is no other priority other than moving forward with the search until you find them. Children’s lives are the most important thing."

Colombian President Gustavo Petro

 

"Information was received from the area assuring contact was made with the four children who were part of the group transported on the aircraft. This report stated that they had been found alive and in good health."

"However, the military forces have not yet been able to establish official contact due to adverse weather conditions and difficult terrain. "

"[Authorities have not been able to] corroborate the information received by the ICBF from various sources."

Colombian child welfare agency statement

The Colombian Air Force has escalated search efforts  (Fuerza Aerea Colombiana)

On Wednesday, the President of Colombia celebrated news that the four children whose mother had perished in a plane crash in a remote jungle area in Colombia's Amazon Basin, had been found, after a ten-day search. Information he said was relayed to him was that an Indigenous Colombian tribe living in isolation in the region had found and were caring for the four children, and that once contact had been made it was arranged to transport the children by sea in a speedboat to Bogota to be reunited with their father.

A day later, the Colombian President had deleted his Wednesday tweet of joyful affirmation the children were safe and en route. Now, the director of the country's child welfare arm informed the media that the children are safe, but communication via satellite had been lost. Teams had been sent to three key areas by the ICBF where they believe the children are to be found, and, said ICBF director Astrid Caceres, she is "very confident" they would be found soon.

 

From a journalist came word that area indigenous communities conveyed the information that the children are in a speedboat with no means of communication, but expected to arrive in a rural area where they could be taken into safe custody. This all began weeks ago, when the plane the children were being flown in from a jungle location to San Jose del Guaviare, a major city in Columbia's Amazon rainforest, experienced engine problems and crashed.

Aboard were the four children, with their mother, the pilot and co-pilot. All the adults died in the crash, but the children were presumed to have survived. In the search that ensued items belonging to the children were discovered and it seemed obvious the children had left the scene of the crash, intending to find help. A search party discovered the plane and the bodies of the three adults at the crash site. A 17-day search commenced involving over 100 soldiers, sniffer dogs and three helicopters.

Although the president made haste to assure his nation that the children were safe and would soon be turned over to the state child welfare authorities, then presumably reunited with their father, the army failed to confirm that the children were safe, which lead to confusion with respect to the president's 'good news' announcement.

According to the owner of the crashed aircraft, Avianline Charters, one of its pilots involved in searching the area was informed the children had been found, and were "being transported by boat down river and they were all alive". At the same time the caution was given that there was a risk to the children safely reaching haven given thunderstorms taking place in the area, that would affect the seaworthiness of the craft they were in.

The group of children, from 11-month-old Cristin Neriman Ranoque Mucutoy, on up to four-year-old Tien Noiel Ronoque Mucutuy, nine-year-old Soleiny Mucutuy, and big brother of thirteen Lesly Mucutuy, the oldest must have had his young wits about him to guide his younger siblings away from the crash site in search of help. But their very wandering about in the jungle created its own problems, making it extremely difficult for rescue groups to discover their whereabouts.

At one point, a rescue helicopter played a message on loudspeakers from the children's grandmother, who asked them to stop moving about, to enable the rescuers to find them. These are themselves children of aboriginal backgrounds, taught some basic elements of self-preservation in wilderness areas, amidst speculation with respect to how they were able to survive. Authorities believe the children clambered out of the wreckage to begin to move through the jungle to find help.

Once search efforts revealed a "shelter built in an improvised way with sticks and branches", assumed to have been the work of the children, the army's search efforts intensified, believing there were survivors to be found. A baby's drinking bottle and partially consumed fruit was found, along with scissors, shoes and hair ties lying among branches on the jungle floor.

The downed aircraft's pilot had reported back to base that he was experiencing problems with the engines, and a few moments later the plane disappeared from radar, according to the Colombian disaster response body. Heavy rainfall, along with giant trees growing up to 130 feet in height conspired to make the search, dubbed Operation Hope, even more of a challenge. There are few roads in such remote regions of Colombia, and access via the river is difficult, leaving air transport as the reliable choice.

The Indigenous Huitoto community develops skills in hunting, fishing and gathering, and the children are descended from that community, known for living in harmony with the remote jungle, and dependent on their singular exposure to self-reliance in such settings, which authorities speculate, may very well be the case with the four children. 

 

The Serrania de Chiribiquete national park in the Amazonian jungle departments of Caqueta and Guaviare, Colombia. Four children survived over two weeks in dense rainforest after their plane crashed. Photograph: Guillermo Legaria/AFP/Getty Images

 

Surviving the Titanic

Luxury White Star Liner 'Titanic', which sank on its maiden voyage to America in 1912, seen here on trials in Belfast Lough, Jan. 12, 1912. Photo: Getty Images/ Topical Press Agency

He was a little boy who was witness to the extraordinary events of his time, a century ago. But like all small children his view of what occurred would resemble nothing an adult, haunted by an existential experience like none other would recall. At age six, he would have no idea that he was a child of privilege, of wealthy parents. To this singular child, and likely other children on board RMS Titanic on its first and only TransAtlantic voyage from the United Kingdom to the United States, there was nothing extraordinary about being on a huge ocean liner sailing across the Atlantic in the company of their parents, with a nanny responsible for their care.

When the great ship hit an iceberg and sank, 52 children in steerage lost their lives to the icy Atlantic. One child who had been on the top deck where first-class passage was located by comparison, perished. Six-year-old Douglas Spedden was hardly aware that something horrible was taking place when he found himself in a lifeboat of nine-metre-length alongside 37 other people, when his last memory was of falling peacefully asleep in his upper-deck stateroom. Among them was his father, his mother and his nanny, so all was well.

 

In this photo taken early in the Titanic's maiden voyage, passenger Douglas Spedden can be seen playing with his top on the ship's promenade deck. The photographer. Frank Brown, would disembark in Ireland and avoid the sinking.

 

It took an estimated half hour, or a little longer for about one thousand, five hundred people to freeze and drown, screaming their anguish, not among those in lifeboats as the ship slowly submerged on that moonless night. Their fear and misery expressed in loud cries for help, from those who had safely evacuated from the ship and floated around it, waiting for rescue, shivering in the dark and the cold. Not as cold as the -2C Atlantic, however.

Their Mayday had alerted all other ocean liners in the region, desperately speeding toward the Titanicm attempting to reach the scene to effect rescue. When recovery ships from Halifax steamed onto the ocean graveyard, they saw masses of human bodies, some of them clutching children to their frozen chests. Little Douglas had been promised, as he was bundled into a lifeboat, that he would soon see beautiful stars in the dark heavens above.

Special edition Polar bear  Steiff

Icebergs surrounded the lifeboats, creating another otherworldly experience for the child who turned to his nanny and remarked "Look at the beautiful North Pole with no Santa on it!". All was well with his world, after all, in the presence of his father, his mother and his nanny. Oh, and his comfort-companion, "Polar", the teddy-bear.

A photograph remains of Douglas playing on the top deck with a spinning top, his father looking on. The photograph was taken by an Irish Jesuit priest, who briefly boarded the Titanic on its first leg, and taking a number of photos over succeeding days, then disembarking as the ship reached its last European stop, to carry on across the Atlantic. Douglas was immortalized, that photograph now among the historical memorabilia of a dreadful maritime disaster.

If Douglas was still alive, he could be asked what he thought of the stars he saw that night. He might, or he might not recall seeing the ship's lights still blazing an hour after its collision with the iceberg. He might remember hearing the band playing on the top deck with its remaining sparse crowds. There were 30 empty seats on the lifeboat that carried Douglas and the other passengers from the sinking ship.

First class hospitality did not in and of itself guarantee rescue, though it certainly did no harm. What did ensure that those in first class would survive while those in steerage mostly did not, was the fact that first class cabins were located on upper levels close to the boat deck for easy access to the lifeboats. Private stewards were in the service of most upper-deck families to efficiently guide them personally to safety.

Douglas Spedden in 1913

While below in steerage passengers were pretty well on their own, trying to puzzle out their way through a maze of corridors, and finding dead ends, as time sped by and opportunities were lost. Douglas, that bright child of privilege, survived the disaster that was the RMS Titanic. Three years later, when he was nine years old, still a child, still vulnerable, his luck ran out.

The little boy chased after a ball he had been playing with at the family vacation home in Maine. There weren't many private cars around at that point of the emerging history of motor vehicles, and their speed was not anything what modern cars can achieve, but the motor vehicle that hit Douglas was said to have been speeding. And Douglas became the first automotive fatality in the state.

Mind Your Brain

"So now we know that pleasure is also encoded by opioids."
"The next time you're hungry and you see the McDonald's arches, that's leading to dopamine release. So it's predicting you're going to get reinforced or rewarded. But dopamine can also predict negative things."
"So if we're eating broccoli it's 10 units of dopamine. But when we're smoking crack cocaine, it's like 10,000. That's why for the average human seeking pleasure how can broccoli, or even brownies, compete with crack cocaine?"
"When you're activating this reward circuit, you're kind of tipping the balance up, and your brain is going to try to bring it down. It engages these compensatory responses."
"What you're feeling the next morning is the exact opposite of how you felt when you were on the stimulus. This would happen with any one of us if we were recreationally using."
"When you're using, you're activating all the circuits. And the next day, or the next week if you have a binge weekend, the circuits are kind of resetting the balance."
Dr. Kim Hellemans, chair, Department of Neuroscience, Carleton University

MedicineNet.com

When humans come abreast of things required for survival, the brain releases a "reward circuit", as part of our evolutionary preparedness for the future of humankind. In primordial times when a successful hunt concluded that would ensure survival in the short term, brain circuits released a cascade of signals encoding pleasure, informing the memory to pay attention to where the successful event took place, so at a later time hunters could return with the expectation of another successful hunt.

The hippocampus was engaged to inform the hunters where they were located, the nucleus accumbens lectured the mind how pleasurable the event had been with its expectations of a good tasting meal that would assure the dawning of another day, while the prefrontal cortex produced a mental note to return to the scene of success and pleasure. The brain is adept through long practise in its evolutionary trajectory in producing dopamine and releasing it to those brain areas alerting humans to survival techniques ensuring longevity.

Researchers have also discovered that the human brain released endorphins: opiates. The ingrained rewards system becomes engaged when we consume a substance such as cocaine, alcohol, nicotine, cannabis or opioids. That reward system becomes engaged in a superphysiological state, enhancing the experience of pleasure directly related to those substances. The complication is that the brain also is geared toward the maintenance of a steady balance (homeostatsis), and so engages in compensatory responses.

1130 opioids brain  Getty image brain scan Getty Images

Responses such as making it impossible for the dopamine to reach its reward potential by pulling the dopamine receptors from their location in the membrane even while  hormones that trigger stress are released, comprising the anti-reward circuits. Once the drug is metabolized and excreted, the high worn away, the compensatory responses are left; in the form of a 'hangover'. But in people gripped with a substance addiction where studies suggest early childhood trauma, the brain's circuits are rewired to blunt the reward baseline.

"That might have to do with depression or mental health, but they have this decreased reward baseline, and in some people, because of their history of trauma, they've got an overactive fear pathway." The stimuli that produce that good feeling in recreational users, makes traumatized people with addiction merely feel normal. Repeated use overrides the brain's stabilization efforts, setting a new, lower baseline to produce tolerance which people attempt to overwhelm through higher doses.

"Their baseline shifts, and people start feeling worse, even when they're not using. And they're trying to get to that level they did the first time they used, and they're never going to get there. This is 'chasing the dragon'."

"They'll say that they start using to feel good, and then they use just to feel normal, and then they're using to stay alive. Because what's happening is that when they're not using, the brain is saying 'Danger! Danger!". These fear pathways are skyrocketing, so you feel horrible and you feel scared. So when long-time users who are in withdrawal say they feel like they're dying, they actually feel like they're dying. Because all these fear pathways are going through the roof."

"All the decision-making in your prefrontal cortex is hijacked by addiction. When we're anxious, stressed, sad, a coping strategy can be alcohol, it can be opioids. And when you have an at-risk population -- people who may have experienced poverty, neglect, childhood trauma, systematic oppression due to the colour of their skin, their sexuality, their ethnic group -- this can certainly be the trigger that sets into motion a series of changes in the brain that may lead to addiction."

The Will To Live

"I thought, 'Oh my God, I can't believe how small she is. We weren't expecting anyone this small. I was stunned, frankly."
"We just sat by her bedside the first six hours. I thought her chances of making it probably weren't good. I told the folks every hour I would update them, but there's a good chance she's going to die."
"Many babies like this go home on oxygen, which I thought she probably would, but no, she weaned off of it [she was breastfeeding well and had no need of a feeding tube]."
"The fact that she's done so well is just such a reward, and just makes the whole team feel wonderful."
Dr. Paul Wozniak, neonatologist, Sharp Mary Birch Hospital for Women & Newborns, San Diego

"It was the scariest day of my life. I just felt very uncomfortable, and I thought maybe this is part of the pregnancy."
"I kept telling them she's not going to survive, she's only 23 weeks."
"But that hour [doctors telling the baby's father he would have but an hour with the newborn before her death] turned into two hours, which turned into a day, which turned into a week."
Mother of "micro-preemie", name withheld on request

"For comparison, at birth she was roughly the same weight as a large apple or a child's juice box", said Trisha Khaleghi, senior vice president and chief executive of the hospital where a premature infant was born weighting 8.6 ounces. That weight and the vastly abbreviated gestation appeared at first to mark the newborn's fate; doctors did not expect her to survive, and nor in fact did her parents. Before her delivery, doctors thought they would be dealing with a baby just under a pound in weight at 400 grams, so when she arrived much tinier, they were in shock.

The baby, named by hospital staff while she remained in hospital as Saybie, is believed to be the world's smallest infant to survive such an early birth. A database maintained by the University of Iowa, Tiniest Babies Registry, indicated that baby Saybie weighted seven grams less than the previous smallest, a baby girl born in 2015, in Germany.

Saybie's mother, halfway through her pregnancy suddenly felt peculiar. A medical examination revealed that she had preclampsia, a condition which is known to cause high blood pressure, and which, if left untreated, can lead to serious, even fatal, complications for mother and baby. According to Dr. Dana Chortkoff who delivered Saybie, the mother had "severely elevated blood pressure"; if the baby were to be saved, it was imperative that she be delivered.

The survival rate in the United States for babies born so prematurely is about 20 percent, so the odds for survival were not great. Saybie wasn't breathing when she was born but she "had a good heart rate", said Dr. Wozniak, leading her parents to make the decision that with a heart rate "they wanted everything done" that might enhance her opportunity to survive against the odds. The baby's diminutive size was a challenge even to access properly-sized medical equipment.

The resuscitation beds' built-in scales could not even register her weight, since they weren't able to go below 300 grams. The first order of business for the neonatal team was a breathing tube. They started with a tube the size of a juice-box straw, cut it down to comparative size, and were able to insert it. The baby was warmed, dried off, given medicine to aid her breathing, and then the wait began.

Medical staff observed that the baby gradually improved over time, gaining weight as they continued to be concerned over the types of life-threatening medical challenges such micro-preemies face; challenges such as brain bleeds, lung and heart issues, but Saybie "experienced virtually none" of the expected complications. Little joyful signs were plastered on the walls around the crib that Saybie was placed in, keeping track of her weight and milestones.

"No more breathing tube", read one of those signs. Another said "Tiny But Mighty."

This April photo shows Saybie at four months old. She was born in December at 23 weeks and three days into her mother's pregnancy. (Sharp HealthCare/Associated Press)

Dr. Wozniak looks beyond the present time and all the hurdles that the baby has somehow managed to transcend. The host of health complications that potentially could have been deadly for a premature infant born before 28 weeks, failed to materialize. Nearly five months after her birth and the prolonged stay in the neonatal intensive care unit, Saybie went home with her parents, a "healthy 5-pound infant".

At last contact between Dr. Wozniak and the baby's mother, the tiny girl's weight was 6 pounds, 2 ounces "and doing great". Still, worries Dr. Wozniak, things could eventually be more concerning as she matures. Saybie could develop mild vision problems, fine motor issues, language delays or other learning disabilities, not known to appear before such infants are of school age. A protocol of regular visits to the hospital's NICU Follow-Up Clinic is set to ensue to help promote her health and growth.

Baby Saybie is believed to be the world's tiniest micro-preemie. She weighed about half a pound at birth, but is five pounds in this photo, taken Tuesday. (Sharp HealthCare/Associated Press)

Nature's Gift and Curse of Tusks to Elephants

"Tooth development has been very conserved during evolution."
"Elephants are no more different from humans than mice are, so it's quite possible that the same gene or genes are involved [in tusklessness in elephants and human toothlessness]."
Irma Thesleff, developmental biologist, University of Helsinki, Finland

"We know tusks play an important role in obtaining food, so if individuals don't have that tool, are they using the environment differently, and could those changes have consequences for other animals dependent on elephants as ecosystem engineers?"
Shane Campbell-Staton, assistant professor of ecology and evolutionary biology, University of California, Los Angeles

"They're [the tuskless elephants of Gorongosa, Mozambique] in fantastic condition, this is a very good habitat [Gorongosa national park] for them, and there's no indication they're suffering nutritionally."
Joyce Poole, scientific director, Elephant Voices research and advocacy group, Gorongosa 

Gorongosa Blog

Science has not yet unravelled the mystery of what causes tusklessness in elephants, but through slow and steady research some progress has been made deciphering the genetic program of mammalian tooth development in general, where scientists have discovered an ancient, widely-shared genetic code. Mutations linked with tooth abnormalities in mice show up as well through genetic studies of humans who have missing or malformed teeth.

Elephant tusks are overgrown upper lateral incisors -- those teeth located right beside the front teeth, before the canines. Tuskless elephants, therefore, don't have lateral incisors. Throughout Africa tuskless elephants are anomalous, found in discrete numbers. Gorongosa is an exception; there a sizeable population of tuskless elephants occur. The tusked elephants were victims of a remorseless civil war which incidentally saw elephants slaughtered for ivory. The tusklessness of those surviving elephants without ivory represented their Darwinian advantage.

The result of that ravaging of the park's tusked elephants is that roughly a quarter of the 700 elephants living in the park are tuskless females. Among humans, missing lateral incisors represent the second most common form of tooth agenesis of which the normal rate of the condition lies between two to four percent, roughly analogous to the rate of tusklessness among African elephants.

Generally speaking, tusks are canines curving to the side and upward in wild boars and warthogs, or they droop downward in walruses, while in narwhals of the Arctic the tusk is a single overgrown canine penetrating through the left upper lip of the animal giving them their iconic 'unicorn' appearance. As multipurpose aids tusks are useful implements. Those incisors are used by elephants to dig for salts and minerals; break off branches to reach foliage; they're used to pry and peel off tree bark; to scoop a calf from a mudhole or lift a resting one to its feet.

Bull elephants contest one another by locking their tusks in combat. Those tusks can each weigh up to and over 45 kilograms, seven times the weight of an average female tusk. Those naturally-endowed implements so useful to the elephants have led to their deaths in enormous numbers by poachers setting out to harvest valuable ivory which has always been in high demand as a beautiful material used to carve detailed pieces of artful objects.

International efforts to have the trade banned have had only partial success, with the ivory so valuable that no amount of protection suffices entirely to acutely limit a billion-dollar illicit and inhumane trade. A situation that has led researchers to consider whether elephants would be better off without those mighty tusks, imagining the loss to the trade should the tuskless trait spread throughout the African population with a little bit of help from scientific human intervention.

This intriguing conundrum has the attention of Dr. Campbell-Staton and his colleagues at University of California who have been comparing tusked and tuskless elephants in Gorongosa, hoping to identify and isolate the genes involved in tusklessness, and to solve the patterns of inheritance. As for example, why it is that almost all the tuskless elephants of Africa are female.

Gorongosa Blog

Examining The Issue

"If we will not change the ways that we are living and the environment and the chemicals that we are exposed to, I am very worried about what will happen in the future."
"Eventually we may have a problem, and with reproduction in general, and it may be the extinction of the human species."
Dr. Hagai Levine, epidemiologist, Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Jerusalem

"I’ve never been particularly convinced by the many studies published so far claiming that human sperm counts have declined in the recent past." "However, the study today by Dr Levine and his colleagues deals head-on with many of the deficiencies of previous studies."
"The debate has not yet been resolved and there is clearly much work still to be done. However, the paper does represent a step forward in the clarity of the data which might ultimately allow us to define better studies to examine this issue."Professor Allan Pacey, Sheffield University, Great Britain 

"The extent of the decline in sperm counts in the Western world revealed in this study is shocking."
"As the authors point out this has major implications not just for fertility but for male health and wider public health."
"[It remains] an unanswered question [whether future generations of children will reflect this kind of reproductive damage resulting from current male declining sperm counts]."
"This study should act as a wake-up call to prompt active research in this area."
Dr. Daniel Brion, honorary professor, clinical embryology and stem-cell biology, Department of Reproductive Medicine, University of Manchester

A doctor is silhouetted as he walks past a poster in a Rome fertility clinic. Alessia Pierdomenico / Reuters

This new study through the Hebrew University and the Icahn School of Medicine at Mount Sinai, New York of which Dr. Levine is the lead author, points out that men's sperm counts have fallen by close to sixty percent since the 1970s. And modern life, it would appear, may be regarded as the fuel that led to this volatile fertility crisis. Experts point to chemicals, pesticides, stress, obesity and tight underwear, reflecting the major factors responsible for the crisis.

The researchers engaged in this project tracked over 40,000 men to reach their conclusions. Their study results were published in the Human Reproduction Update journal. And what they point out is that this startling issue of lowered sperm count could be a harbinger of damage to men's health extending beyond fertility, since lower sperm count has linkage to higher death rates and increased potential of suffering other diseases.

Earlier studies have previously linked declining sperm quantity and quality to chemical and pesticide exposure, along with lifestyle factors that include stress and obesity. But this new research is considered to represent the first systematic review of trends in its examination of over 180 studies in a four-decade period to reach the conclusion that since 1973 overall sperm counts in the West have fallen by 59 percent, and sperm concentration by 52 percent.

"It shows the decline is strong and that the decline is continuing", warned Shanna H. Swan, one of the new study's authors. She added that it was her hope that this broad meta-analysis of previously published literature would stamp 'settled' to uncertainty surrounding the collapse of sperm count and its drivers. The decline is worldwide, but it is in the Western world where it appears to be most pronounced.

The emphasis on men in the West being hit particularly hard, appears to validate the exposure to chemicals connection as cause.

But then, according to Richard Sharpe of the MRC Centre for Reproductive Health at University of Edinburgh, delays in pregnancy with an increasing number of would-be parents prepared to wait while the female partner accomplishes other aspirations like completing her education or starting a business, then beginning a family over age 30, coupled with the declined sperm count of her male partner delivers twice the impact in conception difficulties.

Average sperm count concentration has fallen from 99 million sperm per ml to 47 million per ml, according to the World Health Organization which classes low sperm concentration in the field of less than 15 million per ml. Currently over 15 percent of young men have sperm counts that are sufficiently low to be interpreted as within the realm of impaired fertility, and that number is expected to grow in the future.

Beyond the issue of difficulty in conceiving, resulting from low sperm count and quality, the larger implications are again linked to cardiovascular issues, obesity, cancer, leading to higher rates of hospitalization and consequent mortality. At the present time, men's life expectancy is on the increase as a result of rapid advancement in medical care, nutrition and sanitation.

Expectations among experts, however, envision that trend reversing, should the issue of lower sperm count continue.

The concentration of sperm in the ejaculate of men in western countries has fallen by an average of 1.4% a year, leading to an overall drop of just over 52%, say researchers. Photograph: Alamy

On The Cancer Front....

"Currently, every year we're seeing an increase in the number of cancer cases in Canada. So between now and 2030, for example, we expect to continue to see a dramatic increase in the number of cancers diagnosed in Canada."
"That is a reflection of the growing and aging population. About 90  percent of all the cancers that we expect to be diagnosed in 2017 will be among Canadians 50 years of age and older."
"Declines in death rates have been largely driven by decreases in lung cancer incidence and mortality. So tobacco control in general has had a big impact on our death rates."
Leah Smith, epidemiologist, Canadian Cancer Society

Four cancers -- prostate, breast, lung and colorectal -- remain top of the list reflecting the most common cancer malignancies to strike Canadians. Those four types of cancer account for over half of the diagnoses of cancer and the trend continues into 2017. More people are expected to die of lung cancer than any other cancer, an anticipated number of 21,100 for 2017, representing more deaths from one cancer alone than the other three top-listed cancers in combination (19,200).

Approximately 45 percent of newly diagnosed cases occur in that segment of the population aged 70 and older, according to Ms. Smith. As greater numbers of the population age, so does the number of diagnoses of cancer rise. Cancer is projected to cause death to roughly one in four Canadians. Yet mortality rates have been steadily declining from the time in 1988 when deaths due to cancer were at their peak.

That decline is largely attributable to screening for cancer performed at an increased rate, along with improved treatment, adding up to larger survival rates among women. There are not many families who have missed an acquaintanceship with this dread disease, either from one close, or a number of distant members being diagnosed. And some unfortunate families have been deluged with an incidence of diagnoses that seems to hit just about everyone in the family.

In one family alone an aunt died of breast cancer, and when her niece became a new mother her husband developed osteosarcoma requiring a bone transplant and "dramatic" bouts of chemotherapy. Three uncles then succumbed to lung cancer as a result of lifelong smoking habits. And then the woman's father developed fatal colon cancer. After which her brother was diagnosed with skin cancer. The woman herself was diagnosed then with breast cancer. And then her mother had a soft-tissue sarcoma, dying two years after diagnoses.

Still, survival rates are increasing for some cancers in particular, quite dramatically. Of Canadians diagnosed and treated for cancer, some 60 percent will survive five years or longer. With the exception of pancreatic cancer which has an eight percent, five-year survival rate, representing the most negative prognosis of the 23 malignancies reported on by the Canadian Cancer Society. An estimated 5,500 Canadians will be diagnosed with cancer of the pancreas, of whom 4,800 will die of the disease.

It is estimated that in 2017:

• 103,100 Canadian men will be diagnosed with cancer and 42,600 men will die from cancer.
• 103,200 Canadian women will be diagnosed with cancer and 38,200 women will die from cancer.
• On average, 565 Canadians will be diagnosed with cancer every day.
• On average, 221 Canadians will die from cancer every day.

Lung, breast, colorectal and prostate cancer are the most common types of cancer in Canada (excluding non-melanoma skin cancer). Based on 2017 estimates:

• These cancers account for half (50%) of all new cancer cases.
• Prostate cancer accounts for about one-fifth (21%) of all new cancer cases in men.
• Lung cancer accounts for 14% of all new cases of cancer.
• Breast cancer accounts for about one-quarter (25%) of all new cancer cases in women.
• Colorectal cancer accounts for 13% of all new cancer cases. 

The Cystic Fibrosis Survival Rate Dilemma: Canada and the United States

Survival Comparison of Patients With Cystic Fibrosis in Canada and the United States: A Population-Based Cohort Study

Background:In 2011, the median age of survival of patients with cystic fibrosis reported in the United States was 36.8 years, compared with 48.5 years in Canada. Direct comparison of survival estimates between national registries is challenging because of inherent differences in methodologies used, data processing techniques, and ascertainment bias.

Objective:To use a standardized approach to calculate cystic fibrosis survival estimates and to explore differences between Canada and the United States.

Design:Population-based study.

Setting:42 Canadian cystic fibrosis clinics and 110 U.S. cystic fibrosis care centers.

Patients:Patients followed in the Canadian Cystic Fibrosis Registry (CCFR) and U.S. Cystic Fibrosis Foundation Patient Registry (CFFPR) between 1990 and 2013.

Measurements:Cox proportional hazards models were used to compare survival between patients followed in the CCFR (n = 5941) and those in the CFFPR (n = 45 448). Multivariable models were used to adjust for factors known to be associated with survival.

Results:Median age of survival in patients with cystic fibrosis increased in both countries between 1990 and 2013; however, in 1995 and 2005, survival in Canada increased at a faster rate than in the United States (P < 0.001). On the basis of contemporary data from 2009 to 2013, the median age of survival in Canada was 10 years greater than in the United States (50.9 vs. 40.6 years, respectively). The adjusted risk for death was 34% lower in Canada than the United States (hazard ratio, 0.66 [95% CI, 0.54 to 0.81]). A greater proportion of patients in Canada received transplants (10.3% vs. 6.5%, respectively [standardized difference, 13.7]). Differences in survival between U.S. and Canadian patients varied according to U.S. patients' insurance status.
Annals of Internal Medicine, March 14, 2017

Dr. Anne Stephenson is lead author on the study comparing survival rates in Canada and the U.S. for cystic fibrosis patients. (CBC)

We hear endlessly how it is that most Americans have no interest whatever in having their nation adopt a universal health-care system providing equal access to all citizens, as a social welfare provision of the state. Americans believe that whatever it is they do in any discipline is superior to how nation-counterparts in the developed world manage their affairs. And Canada's universal access to health care as a government-provided duty to its citizens defies the capitalist free enterprise system, so no thank you, very much.

A study just published in the Annals of Internal Medicine renders some extremely interesting data from neutral scientific investigation. Summing it up, Canadian patients with cystic fibrosis enjoy a median lifespan that is ten years in excess of the lifespan expectation of their American CF peers. An inherited genetic disease, CF was 'discovered' in 1938, and therapies that help to raise quality of life to a hoped-for level, along with life expectancy are still in the initial stages.

It is a dread disease, one that severely impairs the lungs and impacts on other bodily functions. The new study was meant to investigate published research to date, to attempt to determine just why it is that differences in lifespan outcomes exist for patients in Canada and the United States. Funded by the U.S. Cystic Fibrosis Foundation, fifty percent of the study's authors are Toronto-based researchers, with the lead author being Anne L. Stephenson, of St. Michael's Hospital in Toronto.

In 1960 the survival rate for CF sufferers was about ten years, and it was raised to thirty years by 1990. In 1994 the United States saw a slightly better survival rate for American CF patients than Canada, but for some unknown reason the Canadian median-survival-age measure began to surge ahead, and from then on began accelerating around 2005. In the period from 2009 to 2013 the estimated median lifetime of Canadian CF patients was 50.9 years whereas for American patients it was 40.6.

The researchers looked for telling differences in the CF databases of the two countries but that revealed nothing. They hypothesized that patients in the U.S. database might be likelier to have a more severe form of the disease, and perhaps be more susceptible to opportunistic infections; even that the specific gene defects were of a different mix. They came up empty, finding nothing to distinguish an advantage for Canadian patients over Americans.

Canadians can count on better care in managing their cystic fibrosis due to the universal health care system, yet Americans who are covered by Medicare or Medicaid do no better in the U.S. than those who lack insurance. There is one thing that has been seen to advantage CF sufferers and that was the high-fat diet for young CF patients that was adopted in the 1970s in Canada, now regarded as the best regimen, one that the United States arrived at at a much later date. Now it's theorized that in mid-life survival for Canadians who were given that optimum diet it might have played a role.

Another factor is lung transplants, where it seems that Canadian transplant recipients are enabled to live quite a bit longer than doctors had anticipated would be the case. While the U.S. uses a nationwide "lung allocation score" system and has since 2005, Canada uses lungs for surgical transplants locally, as they become available, leading the study authors to speculate whether this too may be involved in the longer Canadian lifespan, since under their system, American CF patients are given fewer transplant opportunities.

Erick Bauer, who was diagnosed with CF at age five, poses for a photo at St. Michael's Hospital in Toronto on Monday, March 13, 2017. Canadians with cystic fibrosis have a median lifespan a decade longer than their U.S. counterparts and researchers on both sides of the border are trying to figure out why there's such a dramatic survival gap between the two countries. THE CANADIAN PRESS/Aaron Vincent Elkaim

Medical Trail Blazer, Survivor

"He never talked about it, at least not until the last few years. It wasn't because of some ingrained memories of atrocities or other terrible things. He was just a very forward-looking person. He thought what was going to happen next year was more important than what happened 40 years ago."
"It wasn't really anti-Semitism [suspicion with which Austrian Jews were viewed in Britain]. It was fear of German-speaking aliens."
"A lot of the internees [in New Brunswick internment camps] were Jews and tended to be well-educated and organized. Before long they had a bakery, an orchestra, there was a library, they continued schooling [in the internment camp]. The conditions were probably better than being in the Blitz in London."
"He [his father Hans] tended to ruffle fathers. He wasn't really a team player. His patients tended to like him a lot, but I don't think he was terribly patient with his senior administrators."
Stephen Reichfeld, Canada

"For me the 'upheaval' initially had the pleasant result that there was no school for eight days [April 7, 1938, Austria]. On the first day back at school there was then a celebration for the 'aryan' students. Afterwards, the provisional director of the institute, the gym teacher Schmidt, held a marvelous speech for the Jews at the Academic High School [Vienna, Austria] in which he rambled on about Jewish world Bolshevism and explained that we were now a guest population and should behave as such."
"When they [German prisoners of war] found out that most of the internees on the other side of the wire [aboard the liner Sobieski heading from Britain to Canada, June 1940] were Jews, they went through the repertoire of anti-Semitic songs popular among followers of the Nazi regime. I laughed them off, being more intent on enjoying my first experience of the Atlantic on board an ocean liner."
Hans Reichenfeld, pioneering doctor in geriatric psychiatry

Hans Reichenfeld (1923-2016) was an Austrian Jew who escaped the Nazis and became a pioneer in the field of geriatric psychiatry at the University at Ottawa. FAMILY PHOTO

During the Second World War, Britain asked Canada to take on the reception and internment of German prisoners of war, and Canada agreed, setting up internment camps in remote areas of the country far from populated urban centres. Into those camps went genuine prisoners of war, Nazi military personnel who had been captured during battles in the European theatre of war. Along with the Nazi internees, German and Austrian Jews were also interned.

The fact that they shared a language with the German fascists whose leader was determined to destroy the lives of European Jews and succeeded to an incredible degree did not serve to ensure that the Allies would recognize the differences between the two German-speaking populations; 'aryan' German fascists and German-Jewish victims of genocide. One of those internees was a 17-year-old Austrian boy who, along with his father had been caught in the round-up as an enemy alien when they sought refuge in Britain.

This was a boy who considered all experiences that occurred to him to be learning events, a boy who naturally expressed optimism for the future, a boy for whom bitterness and revenge had no part in his makeup. Born in 1923 Vienna, he was the son of a Jewish physician. His parents took their children hiking in the Austrian Alps, and saw to it that they had a well-rounded education, including formal music lessons.

When Nazi Germany arrived in Austria to "annex" the country, Jews became the primary targets, and Hans Reichenfeld wrote of his experiences and impressions in an autobiography he published in 2006, titled On the Fringe. The "guests" of whom his school's gym teacher expounded were soon expelled and Austria's Jewish population became the target of vicious dehumanization while threats to their existence became compellingly fraught. Leading his parents to send their two children to England for haven.

Once the boy and his father were freed from internment they returned to England, where Hans enlisted in the Royal Air Force but was unable to serve as a pilot as a result of being colour-blind. He was then trained as a wireless technician and posted to Iceland. With the war's end he trained as a doctor and emigrated from Britain to Canada in 1966. A later move to Ottawa saw then-doctor Reichenfeld teach at the University of Ottawa, and working at The Royal Ottawa Hospital, practising psychiatry.

He died in March of 2016.