Comment on Chidiebere Ibe’s viral anatomical drawing of a pregnant black woman

Recently a Nigerian medicine student called Chidiebere Ibe published his anatomical drawing of a pregnant black woman on his twitter page. It went viral, and was immediately picked up—rightly so—by the international press. Ibe correctly observed that darker skinned people are very much underrepresented (if indeed represented at all) in anatomical illustrations.

He definitely has a point. However, there is on aspect of his drawing that I believe could do with improvement. See Ibe’s drawing below.

Chidiebere Ibe’s remarkable illustration that went viral.

Note the area around the genitalia. The illustration shows a cross section right down the middle, the midsaggital plane. It’s reasonably detailed too. You can see veins in blue, arteries in red, both small and large. Cross sectional views of the urethra, vagina and rectum are all fully in the picture, so we are certainly looking at the midsaggital plane. But then what happened to the external bit of the clitoris? See the image below for comparison.

This version shows a good deal more of the female genitalia, with the glans clitoris indicated, and also shows how internal organs such as liver and stomach shift upwards during pregnancy, as the baby grows. I also like the decision here to include a breast, as they increase in size during pregnancy. An anatomically more complete representation, in my view. [Source]

Compare the two illustrations. Disregarding the more cropped view of Ibe’s drawing, I cannot help but question why he drew everything else in that area quite detailed, but then went for what appears to be a partial clitorydectomy.

Whether or not the glans clitoris was intentionally omitted—for example because he considered it irrelevant—I do not know. Strange nonetheless that he did include the internal bit of the clitoris. Considering the fact that in Nigeria the occurrence of female genital mutilation, only made illegal as recent as 2015, remains very high, messing with the genitalia in an illustration that—given Ibe’s rise to fame—is probably also destined for e.g. Nigerian medical textbooks, is not advisable. Did Ibe consider that possibility? Probably not; he understandably seems overwhelmed by all the attention (and that attention, I hasten to reiterate, is still well deserved).

Regardless of Ibe’s motivation, any anatomical illustration, regardless of skin tone, should prominently include the important structures of the genitalia as visible and detailed as any other adjacent/related/relevant structure visible in that aspect of the cross section. Female genital mutilation (FGM) is universally regarded as a fundamental violation of human rights. The disgusting practice of FGM still happens, despite the ban, and that is really what makes this a bit of a sensitive issue. Ignoring that would be simply naive. In my humble opinion, an anatomical illustration should take that into account, where appropriate. For that reason, I would’ve thrown in some extra large labia in there as well, just to err on the side of caution. By the by, I would also frown on any standard medical illustration depicting a circumcised penis. That’s just my opinion: a standard anatomical illustration of the body must be shown naturally, without piercings, circumcisions, implants, tattoos, or any of that. Unless of course explicitly intended for illustrating a medical procedure, for example.

Other than that, I think Ibe’s drawing is a beautiful and very much needed addition to human anatomical illustrations. And I’m certain he didn’t deliberately intend to reflect FGM in his illustration, nor that he was trying to make the picture ‘modest’ in some way for cultural or religious reasons, or whatever. If he just includes at least the same level of details of the genitalia that he dedicated to, for example, the anus and urethra, then you’d really have a perfect picture. Then I believe it would truly be an even more splendid, and more than textbook worthy, illustration than it already is.

On the stupidity of comparing COVID-19 healthcare burden to lifestyle diseases

Here in the Netherlands, as elsewhere, hospitals are again seeing a huge surge in admissions of COVID-19 patients. But this time, as in many other countries, the overwhelming majority of these patients are unvaccinated. The disproportional burden on ICU capacity caused by these unvaccinated COVID-19 patients means that non-urgent care is now postponed in most hospitals.

Those opposing the COVID-19 vaccines (also known as ‘anti-vaxxers’) are rightly blamed for this situation. But the anti-vaxxers themselves disagree with that point of view. One of the more popular responses from anti-vaxxers is the argument that the choice not to get vaccinated is no different than any other life-style choice, like smoking, not exercising enough, eating too much, engaging in sports with high risk of injury, or drinking alcohol. The ardent anti-vaxxer will often claim that these risky behaviours are on equal foot with refusing the vaccine, and go on to remind us that smokers also take up ICU beds. Here I will illustrate why that argument is completely fallacious.

Let’s start with smoking. Smoking tobacco is an immensely complex addiction problem, involving strong physical and psychological dependence. And smoking related illnesses do not manifest immediately. It typically takes many decades before smoking cigarettes leads to disease. We should therefore remember that people who may occupy an ICU bed today because of smoking tobacco, often started this extremely addictive habit at a time when smoking was still allowed in public places and was widely considered socially acceptable behaviour. Furthermore, while a long-term smoker who quits today will certainly experience an enormous health-benefit by doing so, there will nonetheless always remain some permanent damage from the many years of smoking. Medical conditions from past smoking may thus still arise years later, requiring some degree of ICU level care. But this is in no way comparable to ending up in the ICU during a pandemic, when everyone floods the ICUs at more or less the same time by refusing a proven safe and highly effective vaccine. This just doesn’t happen with smoking: they don’t all just get lung cancer in the same year. And when (ex-)smokers do end up in an ICU, they don’t stay there for two to three weeks or longer. Refusing a safe medicine is not the same—at all— as a huge societal problem as tobacco abuse, or any other drug problem for that matter. In many cases, substance abuse is related to genetic factors, socioeconomic factors, and in some cases is considered by specialists to be a form of self-medication for certain mental illnesses. Oftentimes there is not so much ‘choice’ at all regarding this lifestyle. And refusing a vaccine, usually based on misinformation and by simply ignoring common sense, is nothing like that.

Other comparisons anti-vaxxers frequently make involves obesity and alcohol abuse. But just like smoking, these are intractably complex issues that cannot be readily solved in the short term. Extreme cases of morbid obesity are even treated with surgery, for Christ’s sake! How is that in any way comparable to refusing a vaccine? It’s insane! There are nations who have declared obesity a pandemic, and have literally imposed special taxes on certain foods (e.g. sugar-tax in the UK) in an attempt to stem the tide. Again, this has nothing to do with refusing a safe vaccine; an addiction or genetic predisposition to not getting vaccinated is unknown to science. A genetic component to the pigheaded stupidity of the anti-vaxxer also remains to be elucidated.

The final comparison I have seen is that in which the choice not to get vaccinated is likened to the choice to engage in high-risk sports. And for some reason I often hear skiing used as an example. Well, alright, let’s do the math. First we’ll look at COVID-19. In the case of unvaccinated people, let’s say the average risk of ending up in the ICU because of COVID-19 is about 5% and the chance of dying is about 1•6%. Could be more and could be less, depending on the country you look at. That’s 50,000 ICU patients and 16,000 deaths for every one million people. So how does skiing compare? Well, in the US the chance of dying from a skiing accident is just shy of one-in-a-million; for every million people visiting a ski-resort, statistically speaking one of them will die during their visit. ONE IN A MILLION! Skiing is over three orders of magnitude safer than getting COVID-19! An NSAA report from 2011 tells me less than 50 skiing related deaths were reported over a period of ten years in the US (at least from in the >90% of US ski-resorts represented by the NSAA). While every death is one too many, 50 deaths in 10 years is about 0.007% of the US COCID-19 deaths in a little over a year. Thus, comparing skiing to COVID-19 is statistically—in terms of fatality risk— just about the same as comparing a trip to the beach in a Volvo to a goddamn NASA rocket mission to outer space! That is literally how ridiculous the comparison is. So let me learn you something that is generally true: ANY sport or activity that is as dangerous as getting COVID-19 would be declared ILLEGAL immediately, without question. Normal people wouldn’t even be able to get insured for such an incredibly dangerous activity, unless you paid an ASTRONOMICALLY high insurance fee.

So to summarise: COVID-19 is not to be compared to health risks associated with ANY life-style. That has to stop right now. Not getting vaccinated is quite simply both insensible and irresponsible, and unnecessarily burdens public healthcare. Yes, in Western countries we have a lot of freedom. However, while you may very well exercise your freedom to refuse the vaccine, that choice does not liberate you from responsibility and consequence. And believe you me that choices always have consequences. In the absolute worst case scenario, if ICUs get completely overrun, you could very well find yourself being triaged right out of the ICU to receive just standard hospital care, with perhaps in the end some palliative sedation to ease your passing while your wailing loved ones can’t even give you a last kiss. This is a nightmare scenario no doctor ever wants to see, but the unvaccinated seem to be doing everything in their power to make it happen. If you are one of them, then please reconsider. Get the vaccine. It’s safe, it’s extremely well tested, and it really works. It’s never too late to change your mind.

Food review: Fish taverna ‘Estiatorio o Tasos’ (‘Εστιατόριο ο Τάσος’)

Before returning to The Netherlands in the beginning of Oktober, we went on one final excursion to a popular little port-town in Greece called Galaxidi (‘Γαλαξίδι’ or alternatively ‘Γαλαξείδι’). And a friend who currently lives there had recommended a particular fish taverna (‘ψαροταβέρνα’) to try: ‘Estiatorio o Tasos’ (‘Εστιατόριο ο Τασος’; literally ‘Restaurant Tasos’). So we did. And this is my review of that establishment.

Restaurant Tasso in Galaxidi, Greece

It wasn’t busy when we arrived, but we did arrive a tad early for Greek standards and it definitely got busier later. During high-season I would advise arriving early to get a table, or perhaps make a reservation. Otherwise be prepared to wait a little.

I have seen at least two reviews on google mentioning that their meat dishes aren’t the best in town. Now I’m not going to outright say ‘don’t order meat’, but this is a seafood restaurant, located right next to the harbour. What do you expect? Going out of your way to visit a fish taverna in the port and then complaining about their meat dishes, is a lot like walking into a whiskey bar and complaining about their beer selection. We did not order any meat dishes, so I cannot comment on them, but I’m almost certain that they will be just decent at best, no more no less. The seafood, however, is something else!

Fresh ice for the ouzo

First thing we ordered was the horta (‘χόρτα’ literally ‘green stuff’). The patron felt obliged to warn us that this horta was a tad bitter, but I actually prefer it that way. It was still warm when it arrived (which is the way to serve it; in many tavernas it unfortunately arrives cold at your table) and had a light bitter taste to it. Very nice. I would say slightly above average.

Ouzo ‘d’Artemis’ blue — Good ouzo from Athens

We also ordered a little bottle of ouzo, and asked for something not too strong. The waitress suggested this brand of ouzo from Athens; d’Artemis Blue (see photo). The bottle was served together with the original glasses—which isn’t common practice in Greece—and it’s a nice touch that Belgian customers especially will surely appreciate. This ouzo was quite fragrant, full of aromatic volatiles from the aniseed, yet not overly sweet and not too ‘strong’ (which is exactly what we asked for). A good one for sure!

Below is a photographic overview of all the food we ordered; horta, fried squid, fried shrimp, fried fish, and fried octopus.

The fried squid was almost perfect, but we felt it was lacking is a bit of crunch in its crust. The fried shrimp were also very tasty, but didn’t really stand out: no better than you’ll typically find in many other fish tavernas. The fried fish however… WOW, just WOW! This blew our minds! You could literally taste the sea, and these were perfectly fried. Simply one of the best, freshest fish I’ve ever had. The grilled fresh octopus was the second favourite, very nicely grilled; good char, soft tender meat.

En plo‘ ouzo (‘εν πλω’), from Patra.

Half-way through this feast, we ordered a second bottle of ouzo; ‘en plo’ (‘εν πλω’) by the Camari distillery located in Patra. Again a mild variety, but a tad stronger and a bit more neutral than the d’Artemis. And also again, we got two new glasses to match the ouzo brand. This is not common at all, and I think it’s a very nice touch. But when it comes to the flavour, I think I preferred the d’Artemis more; that one is close to the top ten of best ouzakis I’ve had. But this is just my personal taste preference of course. Both ouzos are of excellent quality.

Chocolate tiramisu

We finished the meal with this complementary little sweet: chocolate tiramisu. Not a typical greek desert, but it was still nice and—considering how heavy tiramisu can be—surprisingly light.

The price was reasonable, about average for a decent fish taverna, certainly considering the enormous amount of food we had. We stayed a night in Galaxidi and departed the next day, but not before having a coffee at the establishment next to the taverna. While enjoying a nice ‘freddo cappucino’, we watched a small boat with a fisherman at the helm slowly pass by in front of us as it was leaving the harbour, probably on its way to catch more seafood for that evening’s menu. Straight from the sea onto your plate. I would definitely eat again at Restaurant Tasos in Galaxidi. Recommended.