'Oxford American' Takes On The Sounds Of Contemporary Kentucky

Sturgill Simpson, seen performing at the 2017 Grammys, is one of the featured artists in Oxford American‘s Southern music issue about Kentucky.

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Christopher Polk/Getty Images

  • Dave Evans, “Be Proud of the Gray in Your Hair”
  • Sturgill Simpson, “Sea Stories”
  • Pine Mountain Girls’ Octet, “Pretty Polly” (1937 recording)
  • Locust Grove Octet, “Pretty Polly”
  • Soul Walkers, “Can I Say It Again”
  • Harry Dean Stanton, “Canción Mixteca”

Images of Kentucky are often reduced to coal miners, bourbon, horse-racing and Loretta Lynn. This year, Oxford American magazine has dedicated its annual music issue entirely to Kentucky, and it explores soul jazz, punk rock, rap and more from the Bluegrass State.

The issue comes with a CD of Kentucky music, new and old. Jackson, Ky. native Sturgill Simpson graces this year’s Music Issue cover, showcasing the contemporary sound of the state.

“We were really floored not just by the history of the music but by the vibrancy of contemporary scene, so we knew we kind of of wanted to find someone for the cover who would convey the dual nature of the themes of this issue,” Oxford deputy editor George Maxwell tells Weekend Edition guest host Lauren Frayer.

Oxford American‘s Kentucky Music issue is available now.

Oxford American

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Oxford American

The intersection of old and new is evident in the spectrum of Kentucky artists highlighted. The CD includes recordings from Simpson, Matt Duncan, Dave Evans, Loretta Lynn, the Legendary Shack Shakers, Pine Mountain Girls’ Octet and more.

“Kentucky is unique in a way that it’s not sure whether it’s Southern or Midwestern,” says musician and contributor Nathan Salsburg. “Kentucky itself was this interesting crossroads of river traffic, the frontier of the Appalachian Mountains that Daniel Boone blazed. There [are] all these intersecting and competing factors. In the cities themselves, a lot of this music cross-pollinated.”

“Kentucky was one of the original frontiers of America,” George adds. “It remains in that spirit today. And we can hear it in the contemporary music coming out of Kentucky, too.”

Hear the full conversation, including George and Salsburg’s explanations behind several songs included on the CD, at the audio link.

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2 Protesters Killed As Anti-Government Protests Enter Fourth Day In Iran

Iranian students scuffle with police at the University of Tehran on Saturday during a demonstration driven by anger over economic problems.

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Two protesters were killed Saturday night as anti-government protests in Iran continued into a fourth day.

Demonstrations began on Thursday and thousands have taken to the streets in multiple cities over the weekend, with many protesters calling for the removal of Iran’s supreme leader, Ayatollah Ali Khamenei.

The government warned on Sunday that protesters would suffer severe consequences if demonstrations continued.

“Those who damage public property, violate law and order and create unrest are responsible for their actions and should pay the price,” Interior Minister Abdolreza Rahmani Fazli told Iranian state media, according to Reuters.

Two protesters were shot in the town of Dorud in Iran’s Lorestan province Saturday night, the government confirmed.

The deputy governor of Lorestan, Habibollah Khojastehpour, said foreign agents were responsible. “No shots were fired by the police and security forces. We have found evidence of enemies of the revolution, [Sunni militant] groups and foreign agents in this clash,” according to a Reuters translation of comments on the semi-official Mehr News.

Some demonstrations have turned violent. “Protesters have attacked banks and government buildings and burned a police motorcycle,” the wire service says.

Authorities said Saturday at least 50 protesters had been arrested, The Associated Press reports. On Sunday, the semi-official news organization ILNA said authorities arrested about 80 protesters in Arak, a city southwest of Tehran.

A common element of all protests has been a call for the end of clerical rule in Iran, according to the BBC’s Kasra Naji. The country’s clerics have maintained power since the country’s Islamic Revolution of 1979.

Other motivations behind protests are frustration over economic struggles and alleged corruption, reports say.

President Hassan Rouhani, who has been seen as a gradual reformer, won re-election in May. He championed the 2015 nuclear deal with Western powers that saw sanctions lifted in return for certain limits on Iran’s nuclear development.

But economic benefits of sanctions relief have not yet materialized for average Iranians. Unemployment in the spring of 2017 was 12.6 percent, up slightly from late 2016, according to the World Bank.

President Trump tweeted three times in support of protesters on Friday and Saturday:

Many reports of peaceful protests by Iranian citizens fed up with regime’s corruption & its squandering of the nation’s wealth to fund terrorism abroad. Iranian govt should respect their people’s rights, including right to express themselves. The world is watching! #IranProtests

— Donald J. Trump (@realDonaldTrump) December 30, 2017

“The entire world understands that the good people of Iran want change, and, other than the vast military power of the United States, that Iran’s people are what their leaders fear the most,” he added in another tweet. In a third, he wrote: “Oppressive regimes cannot endure forever, and the day will come when the Iranian people will face a choice. The world is watching!”

Bahram Qassemi, spokesman for Iran’s foreign ministry, said Trump’s remarks and the statements of other U.S. officials were “opportunist and duplicitous” and said it was part of “the deceit and hypocrisy of the U.S. administration.” Qassemi was quoted by the newspaper Tehran Times, which calls itself the “voice of the Islamic Revolution.”

Iranians are blocked from entering the U.S. as part of the Trump administration’s travel ban, a fact not lost on the Iranian government, with Qassemi calling it “spiteful.”

The demonstrations are the biggest in Iran since the disputed 2009 re-election of Mahmoud Ahmadinejad.

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Under 'Kenyan Time,' You're Expected To Arrive … Oh, Whenever

James Yang for NPR

James Yang for NPR

My beach wedding in Diani, Kenya, was supposed to begin at 4 p.m. It started two hours later. The reason: The photographer was late. He shrugged it off, blaming traffic. “I am here now and that is what matters,” he said.

Grrr, “Kenyan time.”

That is what they call it in my homeland.

Unlike in the clock-bound West, where one is expected to arrive at or ahead of schedule, it’s OK to be one or two hours later for an event by Kenyan standards. It is not a big deal at all — that is the true meaning of “Kenyan time.”

And now, “Kenyan time” is a social-media phenomenon, thanks to a new video showing an American man ranting, in English and Swahili, about how Kenyans are always late.

“I define ‘Kenyan time’ as not actually time, just a number used to solidify the event,” said Oregonian and self-professed Kenyan enthusiast Justin Bradford in the video, which was posted in mid-December and has about 25,000 views.

Many Kenyan commenters agreed that, indeed, they are terrible at being on time.

paulinemochama: “So true. My sis was going for a baby shower that was starting at 4pm (supposedly) and she was still getting her hair braided at 6pm and had to go home n change and also buy a gift”

bluetuff1: “hahaha true many Kenyans don’t keep time”

Rosie Lusanji: “Huwaga hawasemi pole, bora wamefika. Woi. [Translation from Swahili: “They normally don’t say sorry—provided they make it.”]

Dennis Karuria: “Sisi hatunanga Haraka Bro. [“We are not in a hurry bro.”] We are the Real African Timers”

TheKEprince: “Hahah was in a company where we used to be at work at 8, but after too much lateness among many people it was pushed to 8.30. I joined the company when it was 8.30 but 1 year down the lane there was a request for 9 am. True we need to honor time as Kenyans and as the global community, it’s very important for us to progress. When someone delays me by 20 minutes, I leave…very simple”

The issue of poor time-keeping is not just a Kenyan problem. It is a problem in Ghana and throughout Africa (and of course in many other cultures as well).

Nor is it new. In 2003, the BBC devoted an episode of its “Africa Live” program to “African time” following the late arrival of a Ghanaian king for a showy ceremonial event in London. A decade ago, Laurent Gbagbo, then-president of Ivory Coast, launched the ” ‘African time’ is killing Africa, let’s fight it” campaign to promote punctuality.

The recent video raises the question, do Kenyans and other Africans respect time? (Some, yes.) Are all Kenyans guilty? (No.) And why is some white dude in Oregon complaining about Kenyans? (Unclear.)

Kenyans exist in time, not for time. Their lives are not defined by seconds, minutes and hours; time is not money. Rather, Kenyans view time as a contextual and flexible variable that individuals have the right to manage however they please. What matters is not the time you arrive but the significance of your presence and participation.

But make no generalizations. While a majority of Kenyans may be guilty of chronic tardiness, plenty are sticklers for punctuality — in some circumstances, anyway. The U.S. Embassy and other embassies in Kenya, for example, are places where Kenyans are on time, or even hours early, for appointments.

The more Kenya folds itself into the global economy through trade ties, business dealings and donor-funded projects with countries such as the U.S. and China, the more its citizens will have to conform to the clock-obsessed culture beyond its borders.

Take the new railway connecting Nairobi to Mombasa. Built and operated by the Chinese, who are far stricter with time, the route’s trains depart precisely on schedule. Kenyans know to be there on the dot. “If there is anything on time in Kenya, it’s the SGR train,” one of my Kenyan friends wrote on Facebook.

Punctuality is also common in schools.

When I was growing up in Mabafweni, Kenya, in the 1980s, arriving at school by 7 a.m. was mandatory. Failing to do so would result in a punishment such as caning or kneeling for an hour on the hard floor. I learned to respect time, which helped me adapt to the U.S., where I live now.

Today, schools still enforce punctuality. For instance, students at the Dr. Ndumi Faulu Academy, which I co-founded with my parents, have to arrive by 7:15 a.m. If they’re late three times, they’re sent home for the day.

Punctuality is a sign of respect and goes a long way toward building trust and confidence. But must it be forced on the many Kenyans and other Africans who still believe in “African time”? Tweet your thoughts @NPRGoatsandSoda.


Esther Ngumbi is a post-doctoral researcher at Auburn University in Alabama. She served as a 2017 Clinton Global Initiative University Mentor for Agriculture and is a 2015 Food Security New Voices Fellow at the Aspen Institute. Reach her @EstherNgumbi.

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Reading The Game: Inside

In Inside, you play as a boy with no special powers — just the ability to run from the monsters around you.

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Playdead Studios

For years now, some of the best, wildest, most moving or revealing stories we’ve been telling ourselves have come not from books, movies or TV, but from video games. So we’re running an occasional series, Reading The Game, in which we take a look at some of these games from a literary perspective.

I begin the game as a boy, on the run from dogs in a dark forest. I end it as something else entirely, lying exhausted on a beach, the dawn sun just beginning to rise. In between, a story happens — disturbing and moving and deeply, deeply weird. There are robots and sea monsters, zombies and scientists, a war (maybe), and possibly the end of the world.

And not a single word has been spoken.

Inside is an experiment. The developers (Playdead, who also made the game Limbo, similar in many ways to Inside) gave it the spine of one of the most primal of videogame forms — the puzzle platformer. You run, you jump, you push things and pull them. There is an internal design language to it that is the common tongue of the videogame world — a thing you know in your fingertips if you know anything at all.

But to that (around it, above and below it) they have added the skin of a terrible (read: wonderful) story of death and darkness and science run amok.

You come to Inside, like I did, in the dark and in a panic. You are a small boy, sliding down a hill. A boy in a red jacket with no superpowers. No guns. No bombs. No name. A boy with nothing but the ability to run and jump and swim. A boy.

There is no tutorial, no pop-ups explaining what the buttons do or what the boy can do. You either know it in your bones, this physical language of button-pushing, or you don’t. But one thing is obvious: something bad has happened, and you (as this perfectly ordinary boy) have to run. Now.

Wordless. Nearly soundless but for the crunch of sneakers on gravel, the scrape of doors. Gasping breath. In the forest, there are men with guns and masks who will catch you and kill you if you are not fast enough. There are dogs that will tear you to pieces. You will traverse the forest, hiding from the searchlights, and then cross the abandoned highway just out of sight of the roadblock, slide down the embankment, splash into the awful, gray puddles. And that’s when you start seeing all the dead pigs.

Inside’s story is all in the visuals — the images of the dusty, silent factory, the flooded laboratory spaces, the city where the brainwashed zombies walk and shuffle and hop in neat, orderly rows. It is in the perfect animations of the boy, sprinting and sneaking; the design that makes nearly all of his escapes so skin-of-the-teeth that you want to watch them through your fingers as the jaws snap just behind his foot rattling over the top of the chain-link fence.

Your love for the boy (and you will come to love that boy) is a protective one. If you are like me, you will hesitate at the edges of things that you know will be dangerous. That will likely get him killed (closely clustered checkpoint restarts are one of Inside‘s few mercies). You will linger at the edge of the water, knowing that something is down there in the depths, waiting for you where you are weakest. You will hear the sound of dogs or massive, earth-shaking explosions going off in the distance and you will crouch protectively behind a wall, afraid to push forward.

But then you will because this is a game, and because forward is the only real option available to you. And because forward is where the story lies. Where the answers are. Like a film-loop, each advancing scene adds to the silent mass of the story that Inside is telling — the living pigs at the farm are infected with some kind of parasite that makes them crazy. Why? How? Why is every person you see either trying to catch you, stop you, kill you, or dead? Or a brainless thing, controlled by some unseen force, shuffling forward into waiting cages and trucks? Where are they going?

Only forward. Always forward, away from you, faster than you can travel. So you follow because you must. Through offices, recently vacated (smoke still curling from an ashtray, a phone ominously swinging near the door) or old, ruined subways.

You run because running is what you’re best at. And the story, wordlessly, tells itself. Or gives you the world, anyway, and lets you tell your own story inside it. You will never even know the boy’s name. You will never know what happened. You will never know the why of anything, but the possibility space it opens in your head will be vast and sad and quiet and full of monsters.

In the end, there is a twist I promise you will not see coming. A deep dive into strangeness that answers nothing and makes every question even more frightening. Who are you, really? And what have you done?

You are just a boy in a world beyond explanations. And you run because there are no other choices. Insideonly tells the story of what you are running toward.

What happens after is entirely up to you.

Jason Sheehan knows stuff about food, videogames, books and Starblazers. He is currently the restaurant critic atPhiladelphiamagazine, but when no one is looking, he spends his time writing books about giant robots and ray guns. Tales From the Radiation Age is his latest book.

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The Friendship Bread Project: Can Baking Promote Unity In A Divided World?

Friendship Bread is the chain letter of baking: A simple starter that you divvy up, keeping some for yourself and sharing the rest with others. It’s an old tradition that connect neighbors through the act of sharing food. NPR would like to see you revive it in your community. Share your stories on social media — use #NPRFriendshipBread — and we might feature your experience in a follow-up story.

Courtesy of Emily H. Landsman

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Courtesy of Emily H. Landsman

Chef Carla Hall had never heard of “friendship bread” before someone gave her a plastic zip-top bag full of a yeasty, mushy starter. As a young caterer just starting out, she got busy baking up a storm and was excited to tell her friend some days later about everything she had made.

Instead of being delighted, her friend just stared at her. “You used it all up?” she asked. “That’s not the point. You’re supposed to just use some of it, and then pass it on to someone else. That’s why it’s called friendship bread.”

Hall was mortified, saying now, “I broke the chain. I literally took her love and bashed it, like it was a one-night stand.”

Friendship Bread — also known as Amish Friendship Bread — is the chain letter of baking. A simple starter of flour, sugar, milk, water and yeast is mixed together and then developed for 10 days at room temperature. The person who makes the starter, similar to a sweet version of a sourdough starter, keeps some to bake up a loaf of bread or other baked items, then they divide the rest to pass on to friends. If a little of the starter is kept, it can become the basis of a new batch of starter.

With families and friends finding themselves frequently on opposite sides of the political divide over the past year, is it possible for tasty treats, baked under the guise of friendship, to provide a respite from the conflict, and even become a source of healing?

Darien Gee thought so when she first heard of Friendship Bread in 2009. In fact, she became so enchanted with the idea that she used it as the basis for a novel — appropriately titled Friendship Bread (Random House, 2012) — the story of three strangers who connect over the bread, forging friendships while coping with personal demons.

“In communities where the starter is actively passed around, touching different households and very different lives, it reflects the commonality among us,” says Gee of why the Friendship Bread concept resonated with her. “We are doing this together, we are in this together. This starter exists because we are all playing a part in this process.”

Gee was initially introduced to Friendship Bread when her daughter came home one day with a bag of starter and some bread. “The story for the novel came to me while I was eating the bread. I had a first draft in five months and, along the way, I kept coming up with more Friendship Bread recipes to help tell the story.” In fact, the recipes became so popular after the book’s publication, Gee found it necessary to create a website devoted specifically to them, The Friendship Bread Kitchen, spawning hundreds of recipes, from biscotti to pretzels, three cookbooks, and over 77,000 subscribers.

The origins of Friendship Bread — and a similar version known as Herman Friendship Cake in Europe — have been the subject of some debate, as is the question of whether the recipe is actually Amish. Anne Byrn, who researched hundreds of historical recipes for her book American Cake (Rodale Books, 2016), remembers the Friendship Bread craze popping up in newspaper columns in the late 1980s, but thinks the recipe can be traced back much further.

“The concept behind it is really old,” she says, “and there are recipes for Friendship Cake, instead of Friendship Bread, that date back to the 1860s. Before the invention of baking powder in 1855, starters were made with wild yeast just gathered from the air, and they provided the leavening for cakes and breads.” Pioneer women traveling the Oregon Trail would have been feeding a starter as they traveled, and certainly would have shared it with each other along the way, she says.

Friendship Cake was particularly popular in the 1930s, according to Byrn, when Depression-era homemakers were trying to be resourceful and plan ahead. The recipe that evolved into the cake-like Friendship Bread some 50 years later, however, took advantage of modern conveniences like dried yeast and even instant pudding.

It’s an evolution that can bring up bad memories for some, such as this comment in a 1990 thread: “Somebody gave me some of that stuff years ago but it was a totally different recipe that used a package of Jell-O vanilla pudding. The resulting bread was super sweet. Not to our liking but my MIL [mother-in-law] liked it. For a couple of weeks. And then she too got sick of it. And nobody wanted the damned starter.”

Indeed, the most common Friendship Bread recipe does include a packet of instant pudding with the other ingredients. It’s reviled by some, but Gee is among those who love it: The moist raisin-and-nut-studded result, liberally topped with cinnamon sugar, remains Gee’s favorite.

“It’s a ‘love it or hate it’ kind of thing,” says Gee. “The use of the instant pudding can be controversial, but I have to admit that, 250 recipes later, I still love the original.”

While detractors decry that the use of pudding mix is a sign that Friendship Bread can’t possibly be Amish, Byrn isn’t so sure.

“A lot of Amish recipes begin with a pudding mix or a cake mix,” she says. “Just because it’s Amish doesn’t mean it’s made from scratch.”

Byrn also points to the 1989 PBS cooking show Amish Cooking from Quilt Country, hosted by the late cookbook author Marcia Adams, as a possible source for popularizing Friendship Bread again. Adams even included the recipe for the starter and the “chain letter” tradition in her cookbook, Heartland: The Best of the Old and the New from Midwest Kitchens (Clarkson Potter, 1991), writing:

“It is my observation that having this starter around is like getting married — it is a real commitment, and it is forever. And like that institution, it gets better with age.”

Emily Landsman hadn’t had much luck in the past with starters, saying, “Previously I’d been able to go for about a month and then they get funky.” But Friendship Bread was different. “This picked up right away, and I’ve been able to divide it and keep it alive.”

A frequent contributor and baker for the Jewish Food Experience, Landsman hadn’t heard of Friendship Bread until asked to give it a try, but now she’s hooked. “I like the fact that you’re supposed to share it,” she says. “I wound up giving [the starter] to my new boyfriend’s good friend’s wife, who is a baker. I knew I’d need her approval, so what better way to connect with her than through bread?”

Beginning with her own standard no-knead bread recipe as opposed to the instant-pudding recipe, Landsman has gone on to make two loaves, one with whole wheat and another with spelt flour, as well as a batch of sesame seeds knot rolls, in the first month. She’s even dehydrated the starter to make it easier to transport as a gift.

Gee thinks the starter is integral to the Friendship Bread experience. “We’ve become so independent and insular as families,” she says. “You can make any of these recipes without the starter but it wouldn’t be the same, because you wouldn’t have this element of sharing and passing it on. It keeps you connected to the community and other people, an approach to cooking and asking that we don’t have a lot of these days.”

And so, here’s a baking challenge for readers of NPR’s The Salt: Make up your own batch of Friendship Bread starter and start a new chain, then tell us about what you made and who you shared with, especially if you’ve shared it with family, friends, or coworkers who have conflicting world views from yours. Post photos of the results on social media and tag them with #NPRFriendshipBread and we may do a follow-up story about your Friendship Bread experience.

“I think any act of giving is the first step in healing a broken or frayed relationship,” says Gee. “I am all about baking with intention, and I’d like to think that the act of baking, coupled with the act of giving, could be the start of a new conversation.”

Can baking promote unity? Let’s find out.

Kristen Hartke is a DC-based food and beverage writer.


Friendship Bread Starter

Courtesy of Darien Gee, friendshipbreadkitchen.com

Yield: 4- 6 cups of finished starter

1 25-ounce package (2-1/4 teaspoons) active dry yeast

1/4 cup warm water (110F)

1 cup all-purpose flour

1 cup white sugar

1 cup milk

In a small bowl, dissolve yeast in water. Let stand for ten minutes. In a 2-quart non-metallic bowl, whisk together the flour and sugar, then slowly stir in the milk and dissolved yeast mixture. Cover loosely with plastic wrap or a kitchen towel and let stand at room temperature until bubbly. This is day 1 of the 10-day cycle. Once the mixture is bubbly, you can transfer the mixture into a gallon-size ziptop plastic bag, sealing and leaving at room temperature, and follow the process below. Remember that the bag can fill up with air as the starter ferments, so be sure to release that air so the bag doesn’t burst. The finished starter can also be frozen in 1-cup increments and thawed when ready to use.

Day 2: Mash the bag.

Day 3: Mash the bag.

Day 4: Mash the bag.

Day 5: Mash the bag.

Day 6: Add 1 cup flour, 1 cup sugar, and 1 cup milk. Mash the bag until well mixed.

Day 7: Mash the bag.

Day 8: Mash the bag.

Day 9: Mash the bag.

Day 10: Pour starter into a non-metallic bowl and add 1 cup flour, 1 cup sugar, and 1 cup milk. Mix well with a non-metal spoon. Divide out 1 cup portions of the starter into separate gallon-size ziptop plastic bags. Keep one bag for yourself and give the rest away, along with these instructions and a baked Friendship Bread recipe of your choice.

Original Amish Friendship Bread

Courtesy of Darien Gee, friendshipbreadkitchen.com

Yield: 2 9″x4″ loaves

1 cup Friendship Bread Starter

3 eggs

1 cup oil

1⁄2 cup milk

1 cup sugar

1⁄2 teaspoon vanilla

2 teaspoons cinnamon

11⁄2 teaspoons baking powder

1⁄2 teaspoon salt

1⁄2 teaspoon baking soda

2 cups flour

1 or 2 small boxes instant pudding (any flavor)

1 cup chopped nuts (optional)

1 cup raisins (optional)

Topping:

1/2 cup sugar

1-1/2 teaspoons cinnamon

Preheat oven to 325 F (165 C). Grease two large (9″x4″) loaf pans and dust with the the cinnamon sugar mixture, reserving the excess.

Mix together all bread ingredients thoroughly and pour the batter evenly into the loaf pans. Sprinkle the remaining cinnamon-sugar mixture on top and bake for one hour or until a toothpick inserted in the center comes out clean and the bread has pulled away slightly from the sides of the pan. Cool for 10 minutes in the pan before inverting onto a rack to cool completely.

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How To Work With Your Doctor On Healthier Goals For The New Year

Dr. James Mold, a family physician and author of Achieving Your Personal Health Goals, says doctors should work with their patients to set mutually agreed-upon goals throughout life.

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Many of us make New Year’s resolutions. Few of us realize them. Maybe it would help to reframe how we handle our resolutions by thinking of them as goals instead.

What health goals will you reach for in 2018? And which, if any, will you discuss with your doctor?

A new book, Achieving Your Personal Health Goals, is a patient’s guide for setting life goals and also planning for the inevitable end. It’s a shift from the usual medical framework that looks at health improvement as a set of problems of sickness to be solved.

Family physician and geriatrician James Mold, who wrote the book, has spent more than a quarter-century thinking about how to use goals to improve health care.

Mold is one of only four Oklahomans ever to be inducted into the prestigious National Academy of Medicine. He’s now retired and living in his native North Carolina, so I was pleased to be able connect with him recently in an interview for Public Radio Tulsa’s Medical Monday.

Here are highlights from our conversation, edited for length and clarity.

Forgive me for asking, but isn’t all health care directed by goals?

You would think so. The concept is that people’s own attention to their health should be directed at some sort of goal that makes sense in how they view health.

If you think health involves living as long as possible, or at least living until life no longer seems worthwhile, then you should do things that help you achieve that goal.

Doctors tend to focus on strategies and not goals. The assumption is that if you do the strategies well — that is, if you cure disease and solve all the health problems — that the goals will take care of themselves.

It worked really well when most of the health problems that we saw were infections or injuries. But it doesn’t work as well for other things — particularly things we deal with these days, like diabetes, hypertension, obesity and alcoholism — those things that aren’t easily treatable.

What if someone had diphtheria and we cured it? Isn’t cure the goal?

A goal is something you want to have happen where it doesn’t make any sense to ask why would we want to have that happen.

Curing diphtheria is not really a goal but a strategy — the goal is to keep you alive. And keeping you alive is a goal because it doesn’t make sense to ask why would you want to stay alive.

We tend to view aging as inevitable and disappointing. So by reframing care as goal-directed aging, then getting old is less a problem than a part of life, right?

My mother, before she died, wanted to improve her balance (a strategy), so that she could get rid of the walker (an objective) so that she could go back to gardening (her goal).

It’s really important to be clear about what a goal is, because if you don’t understand what a goal is, then goal-directed care is no different from what we’re doing now.

Your book is written for patients. You make the point that goal-directed care is mutually agreed upon between doctor and patient. It’s the patient’s goal that the doctor can help the patient clarify and achieve, correct?

No, it’s a negotiated settlement, if you will. One of the nice things about goal-directed care is that it puts the doctor and the patient on equal footing so that they both have something to contribute to the discussion. So the patient knows what their values and preferences are, and what they’re able and willing to do, and the doctor knows what is possible to do. If you put that information together, you come up with something that’s reasonable.

I remember a patient vividly in a small town in North Carolina who came in every week to have her blood sugar checked, and it was always out of control. I did everything I could to advise her as to how to get it under control. So I put her in the hospital and her blood sugar came right down to normal. I told her she really didn’t need to come back every week until she did the things I told her to do. It wasn’t’ going to be under control. And she fired me!

I later learned the reason that she came in every week was because it was a social event for her; she knew everybody in the practice. She saw people in the waiting room and got some attention and she felt the only way she could do that was to keep her blood sugar out of control.

I totally misunderstood that. I think it would’ve been a lot clearer if we could have agreed on the goals up front. Whether I could have gotten that goal from her, if she would’ve admitted to that, I don’t know. But at least we would have had an opportunity to figure out what was going on.

What about goals near the end of life?

Since medical school, one of my missions in life is to try to make medical care more humane. I became a family physician because I thought that was the field that was talking the right talk. By the late 1980s it seemed that the revolution had moved to the field of geriatrics, so I became a geriatrician.

As a geriatrician, I was faced with lots of folks who had incurable problems, and who, as they aged, became less and less functional and less able to participate in meaningful life activities.

I worked at a rehab institute that I helped to establish. We worked with occupational, physical and speech therapists, and they were talking about goals. That’s the first I’d ever heard about the term “goal” in medicine, at least in the sense that I think of it now. That got me thinking, “Why don’t we think in terms of goals?”

Doctors didn’t understand why we needed to think that way. Geriatricians sort of got it.

Since 1991 I’ve been trying to convince doctors that this might be a better way to think, with very little success. One of my non-physician colleagues told me to write a book for patients — that they would get it, and perhaps they could demand a change in the health care system.

John Henning Schumann is an internal medicine doctor and serves as president of the University of Oklahoma’s Tulsa campus. He also hosts Studio Tulsa: Medical Monday on KWGS Public Radio Tulsa, and is on Twitter @GlassHospital.

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Baltimore Residents Blame Record-High Murder Rate On Lower Police Presence

The Western District police station in Baltimore, Md., seen in July, was the backdrop to violent clashes between police and rioters in 2015, following the death of Freddie Gray.

The Washington Post/Getty Images

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For the third year in a row, Baltimore, Md., has had more than 300 murders, reaching a new record of murders per number of residents in 2017.

Some residents attribute the high murder rate to relaxed police patrols in the city following high-profile cases of police brutality. Officers have backed off in neighborhoods, like the one where Freddie Gray was arrested.

The Rev. Kinji Scott, a pastor in Baltimore who’s held positions in local city government, says the opposite needs to happen.

“We wanted the police there,” Scott says. “We wanted them engaged in the community. We didn’t want them beating the hell out of us, we didn’t want that.”

He’s among activists who are calling for police reform to reduce the violence in Baltimore and several other high-crime cities across the U.S. that he says haven’t seen change. That change begins with a conversation between the communities directly involved, Scott says.

“We need the front line police officers and we need the heart of the black community to step to the forefront of this discussion,” he says. “And that’s when we’re going to see a decrease in crime.”

This interview has been edited for length and clarity.


Interview Highlights

On the current state of community safety in Baltimore

When you think about young people who are out here facing these economic challenges and are homeless and living places that are uncertain, and you’re a parent — you’re scared. Not just for yourself really, but for your children.

The average age of a homicidal victim in Baltimore City right now is 31 years old. We had a young man who attended one of the prime high schools, [Baltimore Polytechnic Institute], Jonathan Tobash, and he was 19 years old, he was a Morgan State student. And he was killed on his way to the store. That’s the state of Baltimore right now.

On whether the community wanted police to back off after the death of Freddie Gray

No. That represented our progressives, our activists, our liberal journalists, our politicians, but it did not represent the overall community. Because we know for a fact that around the time Freddie Gray was killed, we start to see homicides increase. We had five homicides in that neighborhood while we were protesting.

What I wanted to see happen was that people would be able to trust the relationship with our police department so that they would feel more comfortable. We’d have conversations with the police about crime in their neighborhood because they would feel safer. So we wanted the police there. We wanted them engaged in the community. We didn’t want them beating the hell out of us, we didn’t want that.

On whether the high murder rate is unique to Baltimore

It’s not. I lost my brother in St. Louis in 2004; just lost my cousin in Chicago. No it’s not unique, and that’s the horrible thing.

On whether Ferguson, the killing of Michael Brown, and the birth of the Black Lives Matter movement has brought change

The primary thrust nationwide is what President Obama wanted to do: focus on building relationships with police departments and major cities where there had been a history of conflict. That hasn’t happened. We don’t see that. I don’t know a city — Baltimore for certain — we’ve not seen any changes in those relationships. What we have seen is that the police has distanced themselves, and the community has distanced themselves even further. So the divide has really intensified, it hasn’t decreased.

And of course we want to delineate the whole culture of bad policing that exists — nobody denies that — but as a result of this, we don’t see the level of policing we need in our community to keep the crime down in our cities that we are seeing bleed to death.

On whether he’s optimistic for 2018

I am not. Because I look at the conclusion of 2017, these same cities — St. Louis, Baltimore, New Orleans and Chicago — these same black cities are still bleeding to death and we’re still burying young men in these cities.

I’m a preacher, I want to be hopeful, but not as it stands, no. Not until we really have a real conversation with our front line officers in the heart of our black communities that does not involve our people who are “leaders.”

We need the front line police officers and we need the heart of the black community to step to the forefront of this discussion. And that’s when we’re going to see a decrease in crime.

Emma Bowman adapted this story for the Web.

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Facebook Removes Chechen Strongman Ramzan Kadyrov's Accounts Over U.S. Sanctions

Chechen leader Ramzan Kadyrov was recently added to a U.S. sanctions list. As a result, his Facebook and Instagam accounts have been deactivated. Guest host Ray Suarez talks with Moscow reporter Charles Maynes.

RAY SUAREZ, HOST:

Now to Russia, where the leader of the republic of Chechnya can no longer post on Instagram or Facebook. Ramzan Kadyrov’s accounts were recently deactivated after he was put on a U.S. sanctions list earlier this month. Facebook says it was legally obliged to act. To explain more, we’re joined by Charles Maynes. He’s a reporter based in Moscow and joins us now. Welcome to the program.

CHARLES MAYNES, BYLINE: Good to be with you.

SUAREZ: First of all, explain who Ramzan Kadyrov is. What kind of power does he hold in Chechnya, which is, after all, part of Russia?

MAYNES: That’s right. Well, so Ramzan Kadyrov is the 41-year-old, largely considered the iron fisted, leader of the Chechen Republic of the Russian Federation. And you might just say that he’s essentially Vladimir Putin’s point man to keep Russia’s Southern Caucasus in line.

The problem with that is that while Vladimir Putin made Ramzan Kadyrov, there are real questions as to whether he can control Ramzan Kadyrov. And there are many, in my view, credible accusations of human rights abuses made against him. These include the extra judicial killings and torture and death of gay men in Chechnya that landed him on the U.S. sanctions list with the now expanded so-called Magnitsky List.

SUAREZ: And he loved social media, particularly Instagram.

MAYNES: You know, what Trump is to Twitter, Kadyrov was to Instagram. He loved the medium, although he is on other social networks. He had 4 million followers, and he used it to praise Vladimir Putin. He would wrestle crocodiles. He would show mixed martial arts fights, threaten the opposition and also praise gunmen, for example, who were implicated in the death of opposition leader Boris Nemtsov. So it was always a controversial platform but one that he embraced eagerly.

SUAREZ: When Facebook, which owns Instagram, took down Kadyrov’s accounts, they said it was because he had been added to a sanctions list. But there are other leaders who are on those sanctions lists, like President Nicolas Maduro of Venezuela, who are still active on the sites. How does Facebook explain its actions in regards to Kadyrov in particular?

MAYNES: Well, you know, Facebook said that they’d made this decision because the human rights sanctions by the United States against Ramzan Kadyrov. And you can debate whether that is the right move for a private company to do. But, you know, you have to take the background of this. Facebook, of course, is under all sorts of pressure and getting a lot of negative press for its role in the Russia election scandal in our U.S. presidential elections. And it seems that it’s trying to more eagerly please government officials by making this move. Certainly, some people see it that way here.

Also, it’s really interesting, in Russia, this isn’t the only bit of social media news that made headlines this week. The opposition leader, Alexei Navalny, released a video on YouTube that called for a nationwide boycott of elections scheduled for March. That video was taken down for reasons we don’t quite understand.

SUAREZ: What does President Putin, one of Kadyrov’s closest allies, as you mention, say about this?

MAYNES: Well, he hasn’t said anything particular himself. His spokesman said that the Kremlin was concerned about this. You know, generally speaking, whenever there are attacks on what the Russians say are free speech here, they like to point out the hypocrisy of the U.S. And that was something actually Ramzan said in a post to Twitter. He said, you know, how do you explain declining, essentially, 4 million subscribers access to information?

SUAREZ: You know, if you’re sitting in the United States and looking at social media, it is remarkable the degree to which these companies have tried to pioneer a kind of placeless-ness (ph) of not particular to one place kind of existence. But when you’re sitting in Russia, does Facebook, does Instagram look like an American company, especially when something like this happens?

MAYNES: Well, that’s certainly the position the Kremlin takes. And they point to the leaked documents by Edward Snowden when he famously issued all these NSA documents that seemed to show up some kind of collusion between Western tech companies and the American government and the NSA, in particular. And that was the moment for the Russians where they said, you know, these Western tech companies want to claim that they sort of exist in a void and they’re not tied to anybody, but in fact, they’re working in some degree – some more, some less – with American security services.

Now, Russians then imposed a new law – a data law which, essentially, demands that Western companies like Facebook, like Apple and others, move their servers on Russian soil. The Russian government says this is to protect Russians’ privacy. But a lot of Russian opposition, for example, are very concerned about this. They see it more as a bid for the security services here to get backdoor access that they really want and haven’t been unable to do because they’re Western companies.

SUAREZ: Charles Maynes is a reporter based in Moscow. Charles, thanks a lot.

MAYNES: Thank you, Ray.

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