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Salsa as a story of everyday life
The 1950s were a time of significant migratory movements in Latin America, with their related cultural exchanges, in which it was common for people of Afro-Antillean origin to move from one place to another taking with them their traditional rhythms (the bomba and plena from Puerto Rico, the Dominican merengue, the Colombian cumbia and currulao, the Panamanian tamborito or the calypso from the Lesser Antilles). With these movements, salsa was born, a new musical genre exploding in lyrics singing about folk themes, uprooting and the marginal 2.
The Latin neighborhoods in New York, including Spanish Harlem and the South Bronx, were, for a long time, the social laboratory in which the creativity of this type of folklore was given free rein, where music was used to describe the problems of everyday urban life, and where Latin immigrants identified their hope in these rhythms 2.
Over time, salsa became widely disseminated throughout Latin America and the rest of the world, thanks to the traditional media. In Colombia, it gained momentum through pianist Richie Ray and the voice of Bobby Cruz. Little by little, Colombian salsa musicians like Grupo Niche, Orquesta Guayacán, and Joe Arroyo, among others, began to put a unique stamp on our country's salsa 3.
With salsa being a widely disseminated musical genre in Latin American settings and a means of expressing everyday situations, these songs often describe complex medical situations which invite us to delve into medical science and reflect on ethical dilemmas.
For Hanes and Newell 4, "music embodies the characteristics of medical humanism (care, empathy, human dignity, compassion) and fosters interpersonal relationships." Therefore, music is a humanist learning tool which helps us understand others' reality.
The White Cradle
The song "La Cuna Blanca" ("The White Cradle") emerged after a tragic accident in the lives of the members of Orquesta La Selecta.
On October 28, 1972, as they were on their way to a concert they were giving in Connecticut (United States), the vehicle in which the Puerto Rican orchestra members were traveling had an accident, killing trumpetist Luis Maisonet and seriously injuring Raphy Leavitt, the orchestra director, who suffered a severe concussion, several fractured vertebrae, rib fractures, and a hip fracture, and had to be treated in the intensive care unit for six months.
Leavitt was in a coma for most of his hospitalization, with apparent neurological fluctuations during which he would hallucinate with stressful visions of a white cradle which affected his sanity. He also had dreams of Luis Maisonet in which Luis would attend the musical events wearing inappropriate outfits and would trigger an outburst of anger in Leavitt 5.
In an interview by Eddie Miró, Raphy Leavitt described the origin of "La Cuna Blanca" in the following neurological state:
"In my unconsciousness I would have those flashes, like people say. As consciousness began to return, I started having these dreams or visions" ...
My mind did not understand
The reason for that vision
That little white cradle
Which my dreams broke.
"Wow, if I told you that it was a burgundy, green or blue uniform, then he would always appear with that suit and a black tie, but wider, and I would even speak harshly to him.. And that's why in the white cradle there is a sonnet that says: if I offended you when I would scream at you in those dreams, forgive me brother, I didn't know you had died"5......
These descriptions suggest that Leavitt may have had hyperactive delirium during his hospital stay.
Delirium is a syndrome with a complex and often multifactorial etiology which culminates in a similar pattern of signs and symptoms related to the patient's level of consciousness and degree of cognitive impairment. Classically, delirium has a sudden onset, a brief and fluctuating course, and improves rapidly if the causal factor is identified and eliminated, although all of these characteristics may vary from patient to patient. Its most characteristic manifestations include attention disorders (inattention or hypervigilance) and environmental perception disorders (delusions or hallucinations) and it causes agitation or underactivity 6. High rates of delirium have been found in intensive care units (70%) 7. Leavitt's delirium may have been tied to his multiple injuries, especially concussion, along with a prolonged intensive care unit stay and, possibly, uncontrolled pain.
After seven months of recovery, Leavitt and his band recorded this song as a tribute to their deceased bandmate, written with a dramatic style and sung in a resilient tone by "sonero" [salsa singer] Sammy Marrero to a cha-cha-chá rhythm which stirred Latin America. In 1973 it was included in the "Jíbaro Soy" album.
La Cuna Blanca is a musical piece, but an unparalleled proof of resilience, changing a human tragedy and catastrophic health condition into a hymn to love, loyalty and friendship which extends beyond the barrier of death.
Love and Control
Families have available resources like cohesion, adaptability, rules, values and the support of the healthcare system, which are challenged when they face critical circumstances; for example, when one of their members has a disabling disease. Usually, one of the family members is designated to be the direct caregiver, and the family dynamic begins to change. If this is not dealt with satisfactorily, a series of disorders may develop, including "caregiver syndrome" 8.
This situation is depicted in the salsa song "Amor y Control" ["Love and Control"] by the Panamanian singer Rubén Blades, published in 1992 as part of the album with the same title. Blades wrote the song while his mother was dying of cancer in the hospital. This song describes the parallel suffering of two families, one dealing with the mother's cancer and the other with a young son's drug addiction.
As I left the hospital after visiting my mother, who was fighting an incurable cancer, I saw a family go by.
In front was an older man, a missus, two girls and several other people.
Holding the man's hand, a young man walked with a bowed head, looking repentant.
He was the cause of a family discussion, of which we became aware when we heard the man yell:
'Even if you are a thief, even if you are not right,
I have a duty to come to your aid.
And no matter how many drugs you use, and no matter how much you abuse us, the family and I have to care for you.
Caregiver syndrome is a stressful situation which may overwhelm and exhaust the available resources, affecting the caregiver's physical health and emotional state, and may modify his/her thresholds for perceiving the suffering and pain of the sick person under his/her care 9. The caregiver's symptoms include stress, anxiety, depression, fatigue, lack of energy, helplessness, constant exhaustion, difficulty in concentrating, irritability, insomnia, inability to relax, palpitations, frequent mood changes, constant apathy, emotional tension, hopelessness, resentment and family and social isolation 10.
I watched them walk away in tears, facing their maze, walking together in the good times and the bad. And I thought a lot of my family, I loved them so much at that moment
that I felt like I was drowning in emotion. That boy and my poor mother: two different people, but two equal tragedies.
The negative impact on quality of life caused by caregiver's syndrome may vary and depends on several factors such as the patient's degree of dependence and age, the coexistence of a psychiatric disorder or aggressiveness in the dependent person, the caregiver's educational level and the primary and secondary support networks 11.
The patient's family, and especially the main caregiver, must be provided with multidisciplinary support, as they make up the social circle in which many of the emotional experiences occur, both good and bad. The family member who assumes the caregiver role is the one who must face these types of situations which are stressful and psychologically demanding.
Something is wrong with my hero
"Something Is Wrong with My Hero" is the name of a song which salsa singer Víctor Manuelle dedicated to his father, Mr. Víctor Ruiz, who had Alzheimer's disease. The single was released in 2015. It relates the experience of severe cognitive impairment seen through a son's eyes.
Alzheimer's disease is a neurodegenerative process of unknown etiology but with various identified risk factors, which causes progressive deterioration of specific cognitive functions like language (aphasia), motor abilities (apraxia) and perception (agnosia), leading to a progressive difficulty in carrying out activities of daily life, with a high impact on the patient, relatives or caregivers, and society 11.
Without wanting to, he entered a world in which there are no sorrows or glories
With each step he takes he erases a memory
I can see that the tree of his life is slowly losing its leaves
And that oak that was strong, falls over in time
And my mother devotes every hour of her day to him
Keeping the promise to love him all her life
And the grandchildren grow and the family gets big
And if his eyes could talk, I'm sure they would say
That he still knows us
Alzheimer's disease is the most common cause of dementia and one of the main sources of morbidity and mortality in older adults. Looking to the future, and considering the population's increased life expectancy, the need for social and healthcare resources for this clinical condition is likely to increase. Thus, it is very important to develop and optimize treatments, as well as healthcare plans which can reduce the socioeconomic impact of Alzheimer's disease on the population 12.
It is often said that Alzheimer's disease is a disease of the whole family, because the constant distress of watching a loved one slowly deteriorate affects everyone equally. Therefore, comprehensive treatment should address the needs of the whole family. This includes emotional support, psychological counseling and educational programs about the disease for the patients and their families.
The importance of the humanities in medicine
Medical humanities are privileged cross-cutting instruments of understanding and healing, as they provide training in the use of critical thinking, problem solving and a comparative focus, while teaching empathy. Other skills also find a place in this historical-narrative epistemology, using such different materials as works of art, literature, movies and music 13. These innovative forms of communication can play a very important role in the diagnostic process as well as in medical practice 14.
However, these observations should not be thought to counter current medicine: evidence-based medicine (EBM) does not conflict with narrative-based medicine (NBM), they are complementary. In fact, EBM reduces knowledge uncertainty and NBM improves the relationship between people. A novel, painting or musical composition may represent a culture or historical period, but they can also give voice to different experiences, documenting particular situations and points of view 15. In addition, let us always remember the premise that we doctors can sometimes cure, often relieve, and always console, and art can often provide comfort.
