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Black Swans, Buses, Broken Bones & Bad Ideas

          “rara avis in terris nigroque simillima cygno “ (a rare bird in the lands, and very like a black swan“)

                                                                     Juvenal, @ 110 AD


In ancient times, it was once believed that Black Swans did not exist… but like a lot of overly confident human assertions, the entire assumption had to be reinterpreted when black swans were discovered in the wild. Dr. Nassim Nicholas Taleb, Lebanese-American essayist, scholar, statistician, former option trader, risk analyst and all around very smart guy wrote a highly impactful book about what he calls The Black Swan Theory to explain:

“ 1.) The disproportionate role of high-profile, hard-to-predict, and rare events that are beyond the realm of normal expectations in history, science, finance, and technology.

  2.) The non-computability of the probability of the consequential rare events using scientific methods (owing to the very nature of small probabilities)

  3.) The psychological biases that blind people, both individually and collectively, to uncertainty and to a rare event’s massive role in historical affairs.”

Covid-19 is definitely the black swan of our age.  But is the Black Swan the virus? Or the response to the virus?

Out here on the edge of the jungle I generally spend my waking hours involved with a lot more practical and pedestrian issues… like getting patients through the lockdowns to the hospital, like how much food and medicine do we have left, like how to navigate the next stultifyingly hot and hazy day while trying to anticipate the next stultifyingly hazy mandate of the powers that be.   Strange as it may sound, other than worldometer stats and a lot of breaking medical articles and dialogues, I don’t spend much time at all keeping track of the Covid-19 news up in the USA (which from this distance seems to be all of the news up in the USA).  I only stay current as it bears on the lives of our friends and family there (which is a LOT), and as it bears upon the decisions made by Honduran Authorities, and how that effects the life of Loma de Luz… (which is a WHOLE LOT).  

Questions & Unintended Consequences 

But for better or worse, what the 500 lb gorilla does…. can only be ignored at one’s peril.  So one of my primary sources for such news is a very good friend who lives up in the USA, and currently seems to spend most of his Covid-19 Mandatory Shelter at Home days, drinking a lot of Loma de Luz Coffee, asking a lot of good questions, and reading a lot of the Wall Street Journal, then sending me a lot of links to the best articles.  One of the articles he recently sent was by Holman Jenkins, with the title, “The Lockdowns were the Black Swan”.  I thought about imbedding a hotlink to the article, but decided it might appear to cross the line in taking sides in politics, a line I try hard to stay ‘this side of’ with anything I write about Loma de Luz or the Cornerstone Foundation. You can of course look it up as fast as I can say Duck Duck Go.   But I can say that it asks some good questions. And, I’m all in for asking, “Why?”

 It was questioning why which led me as a skeptical young man to read the Bible through in the first place.  And it was reading the Bible through which led me to becoming a Christian.  So, I highly recommend the question.  I’ll leave it up to you to make your own decisions as to whether Covid-19, the disease… is the Black Swan of our age… or is the Black Swan the monolithic lockdown mandates of global governments.

As I said, at Loma de Luz we are more involved with the practical matters of dealing with the Black Swan than dissecting it.   I have written previously about how what might be a Developed Nation solution doesn’t necessarily make it a Developing Nation solution, and how the governmental response of Toque de Queda Absoluto, (nationwide lockdown), has brought about the unintended consequence of massive unemployment and the inability to purchase food, and extreme difficulties of distributing food here.  We are still involved with that effort (and thanks in part to the generosity of several of you toward that end).  This blog is more about how these universal lockdown policies in this developing nation are causing another, I’m sure unintended consequence: that of widespread suffering from blocking access to medical care.

Treatment Just Stopped

 In the first week or so of the nationwide lockdown, we were still too busy with the patients already here to notice the magnitude of the sea change.  We began to receive patients telling their stories of the tremendous difficulties they had overcome to work their way through or around all of the police and military roadblocks to get to us.  We each heard different accounts of the hysteria that had seemed to possess public health decision makers.  The entire maternity service at the largest public health hospital was closed because one woman had tested positive for Covid-19.  Dialysis centers were shuttered.  Laboratories nationwide were closed and/or couldn’t get the reagents transported to do the labs.  Pathology services to diagnose cancers, autoimmune and genetic disorders, connective tissue disorders, infectious processes from tuberculosis to AIDS… all shut down.  Urgently needed surgical intervention; from shunting a hydrocephalic baby to relieving an obstructed kidney, to attending to broken bones, across the country were deemed non-essential or the patients simply couldn’t get to medical care through the military cordons. 

On one day we received three young guys directly from the same emergency room in another part of the country, two with broken tibias, and one with a broken femur.  They had all three been laying side by side in the same emergency room without treatment for over a week, before they heard of Loma de Luz and their families literally carried them here.  This now seems to be the rule not the exception of suffering across the country.  

  • WHAT will be the long-term consequences from somehow imagining that there is a magic ‘Pause Button’ for all other health needs, for fear of the unknown threat of one new infectious disease? 
  • WHY is absolute lockdown of Honduras the answer to one infectious disease but has never been the answer for any other infectious disease, even similar highly infectious lower respiratory RNA virus’s?  

At press time there have been a total of 61 known deaths from Covid-19 in the 47 days that SARS-C0V-2 virus has been known to be present in Honduras.  That is a daily death rate of just under 1.3/ day. Yet in a country with 46.5 times fewer cars per capita than the USA, the daily death rate from Motor Vehicle Accidents in Honduras is about 4 times the daily death rate from Covid-19.  No doubt forbidding all traffic to “authorized only” (the state we are currently under)  will diminish the daily death rate from Motor Vehicle Accidents… but at what cost? And all of the unintended consequences? And considering that you are 4 times as likely to die in a car wreck in Honduras as to die from Covid-19….Why has absolute lockdown never been the answer to Motor Vehicle Accidents in the past?

Questions: The Best Way to Gain Deeper Insights & Develop Innovative Solutions

I guess at Loma de Luz we do ask a lot of questions…. But we also look for solutions.  And, in the case of government regulations, since we don’t really have much of a voice in changing them, we look first to working with the local authorities in how to interpret them, how to work within the guidelines of the authorities and how to help them in interpreting those often vague blanket restrictions.  Part of the Grace God has shown to Loma de Luz, is that for some years we have been able to say, we generally have excellent local and regional authorities. And we have excellent relationships with our local and regional authorities. Our mayor is a big advocate of Loma de Luz and has helped in everything from interpreting the “no religious celebrations” to allowing us to continue our Thursday evenings corporate prayer (on the DL), to helping us get the Harvest Aviation Flight tests, reagents and materials across the country. The State Public Health Director has designated Loma de Luz the regional test collection center (and had high praise for us as the best prepared hospital he has seen). 

Then, there was the town hall meeting a few weeks ago.  With the fear cranked up by the international 4th estate to a febrile pitch and the village Patronatos (town councils) carrying their pitchforks and torches wanting to close all of the borders to all outside patients, Isaac and Chrysti, two of our missionaries, were at the meeting to represent us.  What we were offering was a bus and driver as well as medical screeners to meet and pick-up the poor patients who could make it to the border of Colón and bring them to our mission Hospital.  It was the mayor and the two young Public Health Service doctors who spoke up in support for this plan… and the mood turned a 180º, and the plan was approved. We have been following this process ever since.  

Our old bus keeps breaking down every other day, so we frequently have to rent a smaller one. (We are currently fundraising for a replacement bus.) But it is those two young Honduran Public Health doctors who are out at the Retén, (the roadblock into Colón) every day screening those patients and working closely with us to get some of the patients from all over Honduras in to us, for the care they urgently need. 


Broken Bone? Get WhatsApp, Ketamine, Missionaries & YouTube 

But what can you do when either the local government won’t work with you or it is beyond local government?  Our solutions at Loma de Luz so far have been to look for creative work-arounds while staying within the bounds of the letter of the law. Here is a little example.  Last week we were contacted on WhatsApp by Ms Peggy, the Founder and Director of Clinica Esperanza on Roatan, an island off the coast of Honduras.  Peggy is an extremely generous good friend and not infrequently contacts us for help with patient problems. Peggy had in her clinic that day a 6 year old boy named Josue, who had been roughhousing with his primo last Sunday. They fell together and when the dust settled, this is what their XRay of Josue’s right arm looked like:

In “normal times,” I would have told Peggy just to splint it and send him over on the Ferry.  This both bone forearm fracture is a very unstable fracture, and they can be quite difficult to both reduce, hold the reduction in place and get good cast fixation all at the same time… particularly without fluoroscopy. 

Sometimes the fracture needs to be opened to get a good reduction. We have the equipment and the expertise to deal with this here at Loma de Luz, and in “normal times,”  we wouldn’t have thought much of it, but just taken care of it as soon as the boy and a parent could get here.  

But these are not Normal Times. In Roatan, the entire island of @ 80,000 people is locked down; nobody in or out.  Of the grand total of 23 tests that have been done on Roatan, none have turned up positive for active SARS-COV-2, so it is assumed by the powers that be with their fingers crossed that there is no virus there. 


The ferries are shut down, the planes are shut down… they have even kept boats in trouble off shore…. Crazy…. Particularly considering that pretty close to half a million foreign cruise ship visitors from all over the world set foot on the island in the few months before lockdown.  Go figure.  Anyway, Josue is stuck with a bad break on Roatan and there is NO Orthopedist on Roatan.

Peggy has a good young Honduran GP doctor (Dr. Ayon) working in the clinic. They have Ketamine, and they have plaster and cast padding… and they have internet access, and they’re willing to give it a shot.  

Our Cast of Characters:

So, Kyli & Reagan & Andrew & I put together a little video as a work-around, (in our spare time).  Andrew is our great P.A., Kyli is a smart and capable young woman, currently volunteering as a teacher at the school before she eventually goes to medical school –  and in this case filmed and put together the video on her phone. Reagan is one of our great Teachers at El Camino who also doubles as a method actor brilliantly portraying a 6 year old boy with a broken arm… on Ketamine. Oh, and Dave Fields helped in the background to get the YouTube Instructional up online. The video shows how to make the cast to stabilize, then cut the cast where the bones needed setting, then how to set the fracture and hold it in place by bridging the gap.  The whole work-around actually worked reasonably well.  Here is the result. 

While it’s not perfect, the bones are well aligned and fixed in place by the cast, and as long as the fracture doesn’t fall off before it sticks in place, a six-year-old will heal and remodel the bayonet apposition of the radius and end up with a good functional hand.

We thought about making the entire 15 minute YouTube video available to you online, but hesitated when we considered that if your state and federal Shelter In Place Mandates are extended for much longer your kids might try it out on the neighbors in the garage…. And be put in jeopardy of hard jail time for violation of some “social distancing” code. So here are a couple of stills from the video.  

But then….those of you up in North America still have access to medical care for broken bones….. don’t you???  If not, stay tuned for our next multimedia presentation, “Practical Neurosurgery you can do in your kitchen.”  You’d be surprised what you can accomplish with a can-do attitude, a work-around spirit and a YouTube video.

It’s Not Normal Times 

But what do you do when the rules laid down from on high just make no good sense, AND the local authorities can’t or won’t work with you, AND your workaround gets shot down AND the consequences of a really bad idea will be really bad if you just sit on your hands?  Well, I’m certainly not advising anyone to break just and rightful laws.  I am thoroughly mindful of the scripture’s clear instructions (in several places) to obey legitimate authority.  

Paul’s letter to the Romans, Chapter 13, for a good example enjoins us to be “subject unto the higher powers”…..explaining that legitimate authority is “ordained by God”. But the same passage instructs us how to distinguish legitimate authority…..

          “For rulers are not a terror to good works, but to the evil.….. do that which is good, and thou shalt have praise of the same:………..For he is the minister of God to thee for good. …….a revenger to execute wrath upon him that doeth evil.”

Certainly Peter and John didn’t back down before the Sanhedron in Acts Chapter 4:

          Then they called them in again and commanded them not to speak or teach at all in the name of Jesus.  But Peter and John replied, “Which is right in God’s eyes: to listen to you, or to him? You be the judges! As for us, we cannot help speaking about what we have seen and heard.”

 Some Ideas Are Bad Ideas

But I’m not even calling for that.  What I am saying is that some ideas are just bad ideas.  Some laws are just bad laws. And people are hurt by bad ideas and bad laws.  When you notice that things just don’t seem to make good sense, it might be because they don’t.  When one test for an infectious disease which can be cheaply and accurately done at your local hospital is prohibited and only the complicated expensive test which has to be sent off to be interpreted at the central authority’s lab is authorized, you’ve got to wonder.  And when the sale of liquor and lottery tickets in your city is authorized “for public safety”, but the sale of vegetable seeds is prohibited, you’ve got to stand up, raise your hand, and ask, Why?

At least that’s how we look at the Black Swan from out here on the edge of the Jungle.