Saturday 29 April 2023

Lupine Publishers | Necrosis as a Step of Tissue Repair

 Lupine Publishers | Journal of Biotechnology & Microbiology


Cell death is a crucial step of tissue regeneration, but massive cell death is a cornerstone pathophysiological mechanism of tissue destruction. Let’s consider some specific aspects of tissue necrosis and its predecessors.

First of all, tissue destruction always occurs on the background of septic or aseptic inflammation. Any type of inflammation causes the increase of interstitial fluid at least due to a sodium flow from a cell. That is a crucial moment because at some point cells lose their intracellular fluid and this is the exact marker of cell destruction regardless of whether this is a consequence of cell compression or a breakdown of cell stromal components. We can state it because necrosis does not depend on the cell cycle that means that this process is not related to nuclear reactions. Based on this approach we can explain why some tissue can withstand the edema more effectively than others. For example: nerve tissue is extremely sensitive to edema, and we can assume that this is a consequence of a relatively small amount of plasmogel in a nerve cell. It exhausts its possibilities of intracellular fluid loss very quickly. A striking example of this is death of central and peripheral nerves due to edema of nerve fiber regardless of compression. Undeniably, the impact of perineurium and epineurium is incomparable with the capabilities of adipose tissue where the number of organelles is minimal and the cytoplasm is predominantly filled with liquid contents. This specificity is particularly significant for preservation of viability of parenchymal and alveolar organs with variety of pathologies and, of course, for the periphery. In my surgical practice I have often seen complete anatomical recovery of limbs after the treatment of gangrene. I mean bypass operations for people with atherosclerosis and diabetes, frostbite apical necrosis of extremities, who had indications for surgery but they refused amputations and I had to dress wounds for a long time. Wounds, even extensive, that are prone to chronic inflammatory process, are always accompanied by hyper granulation during the period of healing, while acute surgical wounds – almost never. A reasonable question “why” arises. I think that long-term leukocyte phase can form some type of memory that is why autoimmune needs for maintaining inflammation are not updated every moment but are supplied with the usual amount of cytokines protractedly. Thus, if initially cytokines “catalyzed” inflammation, then with the time immunize and, possibly, even form antibodies to TNF family, suppress the pro –inflammatory effects of a number of interleukins. Hence, necrosis clears the way for tissue repair.

Read More About Lupine Publishers Journal of Biotechnology & Microbiology Please Click on Below Link:

Friday 28 April 2023

Lupine Publishers | Chronic Kidney Disease, Data from MIKD

 Lupine Publishers | Journal of Urology & Nephrology


Chronic kidney disease (CKD) is a leaping up public health matter. It has an augmented effect on cardiovascular diseases and affects every system in body. In developed countries the extent of prevalence is available due to renal registries. In middle or low socio economic countries the proportion of this evolving health issue is not known. CKD is rising and a major contributor is soaring number of diabetes mellitus worldwide. Other significant addition in this cohort of CKD is by rising numbers of obese and hypertensive patients. In order to curtail this rising health matter immediate and intense measures both at preventive and curative levels are required.

Aim: Due to lack of formal renal registry we wanted to see spectrum of chronic kidney disease (CKD) in our catchment area and at what CKD stage they present to tertiary care hospital.

Methods: All patients who presented to Emergency department of Multan Institute of kidney disease from 01 Sep 2017 till Sep 2019 data were evaluated. Record of Emergency department patients were taken from electronic system of our hospital. Some patients had multiple visits and we took first visits kidney function in our analysis. eGFR was calculated from serum creatinine with help of CKD-EPI equation.

Results: Total 4303 patients were included in study. Males were 60% and females 40%. Age range from 13 years to 96 year old. 945 patients were excluded as they were not falling in chronic kidney disease category. Remaining 3358 patients had chronic kidney disease. Sub-analysis according to CKD stage showed 66.17% patients presented at CKD stage V.

Conclusion: Kidney disease is rising globally. Countries where renal registries are established provide incidence of chronic kidney disease ranging from 10 to 15%. Still a lot of countries worldwide do not have established system of data collection so true incidence is not established. Our work is first of its kind reported from this area. Drastic preventive strategies are need of time from health budget planners.


Multan Institute of kidney diseases is a tertiary care nephrology and urology hospital located in Multan (Largest city) in South Punjab, Pakistan. Catchment area include Multan division, Dera ghazi khan division and Bahawalpur division. According to last census the total population of these 3 divisions is just over 34 million. All patients who presented to Emergency department of our institute from 01 September 2017 till 01 September 2019 were taken from electronic medical record of hospital.

Inclusion & Exclusion Criteria

Total number of patients in our data are 4303. Patients from Age 13 year and above were taken in study. Less than age 13 were not included. Maximum age recorded was 96 year old. In case of multiple visits to Emergency department by same patient, only first presentation kidney functions were included in study and subsequent visits kidney function were excluded. 467 patients had normal kidney functions, normal urinalysis and no structural abnormality on renal imaging and were excluded from interpretation. 478 patients were found to have acute kidney injury as per acute kidney injury network (AKIN) classification. These patients were also excluded from analysis. Rest of the patients (n=3358) had chronic kidney disease [Table 1].

Table 1:


Kidney Function Measurement (eGFR)

Serum Creatinine was taken to measure estimated glomerular filtration rate (eGFR). Various methods of eGFR calculation are available, including the Cockcroft-Gault equation, MDRD (Modification of Diet in Renal Disease) Study equation, and the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation. We took CKD-EPI for measuring eGFR. Patients were divided in CKD stages from 1 to 5.

CKD Stages and Prevalence

Total 3358 patients were identified with chronic kidney disease. Majority (n=2222) of patients presented when eGFR was <15mls/min for the first time to tertiary care facility. CKD stages with number of patients in each group are in following Table 2 [Figure 1].

Table 2:


Figure 1:


Causes of CKD

We analyzed our data to look into etiologies of chronic kidney disease. It showed 30 % patients had diabetic kidney disease and same proportion were hypertensive nephropathy patients. Next in line was obstructive nephropathy with 23.85%. Glomerulonephritis was about 4.5% and roughly 10% patients cause was not established as they presented late. Inherited diseases were just over 1% and interstitial nephritis was just 0.47% [Table 3]. Among the patient cohort diabetic kidney disease was separated based on presence of diabetes mellitus and one of the criteria (proteinuria, normal size kidneys, diabetic retinopathy on fundoscopy or >5 years duration of diabetes mellitus). Nearly 30% of total patients had diabetic kidney disease and more than 2/3rd of them had CKD-5 on presentation. A detailed analysis of CKD stages of diabetic group is in following table [Table 4] [Figure 2].

Table 3:


Table 4:


Figure 2:



Chronic kidney disease is rising worldwide. It has big impact on health economics [1,2]. Developed countries have registries showing its prevalence which helps in health budget planning. Unfortunately under developed countries lack such planning. In Pakistan recently a national renal registry has started working and will give informative statistics regarding renal disease spectrum. This will help in health management planning and focusing on areas where rampant growing renal issues are focused.

Reviewing published data spectrum of renal disease is variable in different geographical areas [3, 4]. Ethnicity, dietary habits, use of herbal medicines, low birth weight & climate all have been postulated as contributing factors in prevalence of chronic kidney disease. According to a Meta-analysis, chronic kidney disease has prevalence of 11% to 13% globally [5]. In Pakistan studies published on chronic kidney disease prevalence are usually from tertiary hospital or region based [6]. Tertiary care centers are in urban cities so there is no good data from rural areas. South Punjab of Pakistan majority comprise of rural area. According to last census the population of south Punjab 3 divisions (Multan, Bahawalpur and Dera Ghazi Khan) is 34 million [7]. This is the catchment area served by Multan institute of kidney disease (MIKD). MIKD is an emerging kidney institute in this area. We analyzed all patients who presented to Emergency department of our institute. We analyzed presentation creatinine and used CKD-EPI Creatinine Equation for eGFR calculation as recommended by the National Kidney Foundation [8]. Chronic kidney disease in Pakistan is on rise and presentation to specialist center is late. Majority of patients present with CKD-stage 5 requiring dialysis. Our hospital’s 2 year record tells us that 66.17% patients who attended Emergency room were at CKD-5 and majority required renal replacement therapy. Diabetic kidney disease was alarmingly on 29.66 %. Further sub analysis of diabetic kidney disease patients revealed that majority patients (72%) were at CKD stage 5 when presented to hospital emergency department. We labelled diabetic kidney disease based on presence of one of the following criteria’s (established diabetic retinopathy and/or micro albuminuria and/or long duration (>5 years) of diabetes mellitus). Further stage of CKD was established based on CKD-EPI calculation. Diabetes mellitus is at tremendous rate in Pakistan. International diabetes federation data reveals that 17.1% rising adult population of Pakistan is now living with diabetes mellitus [9]. With such enormous rise in diabetics in last decade, the burden of diabetic nephropathy is on rise too. In rural areas a lot of people are undiagnosed and usually present to health facility with end organ damage. According to systematic analytic study done in 2016 prevalence of diabetes mellitus in Pakistan is more in males as compared to females and more common in urban areas [10]. The rising burden of diabetes is imputed to environmental and emotional changes. The main contributors are sedentary lifestyle including internet and TV usage, caloric rich diets leading to increasing obesity. Pakistan with very high numbers of prevalent diabetes needs a cost-effective population based approach for screening [11]. Obstruction leading to chronic kidney disease was immensely at 23.85% in our studied population. Obstructive nephropathy due to stone is highly prevalent in this area and reviewing published data the number is almost 2-3 times in comparison to other parts of world. Nephrolithiasis is a highly prevalent disease worldwide with rates ranging from 7 to 13% in North America, 5–9% in Europe, and 1–5% in Asia. Due to high rates of new and recurrent stones, management of stones is expensive and the disease has a high level of acute and chronic morbidity [12]. Epidemiologic studies have demonstrated that the stone risk incidence increases with Body Mass Index, through multiple pathways. Metabolic syndrome and diabetes are associated with an increased renal stones disease incidence [13, 14]. There is a known high incidence of stone disease in Pakistan as this country belongs to the so-called stone belt [15]. In summing up our chronic kidney disease burden we have identified Diabetic kidney disease, Hypertension and Kidney stones as our bulk. This helps in health budget planning and preventive strategies to cut down disease load. Lack of renal registry in Pakistan has been emphasized [16]. Recently at national level Pakistan renal data system (PKDRS) is established and will provide data from all parts of country in coming years [17]. Curtailing diabetes will have significant reduction in diabetic kidney disease and strategies have been proposed. Creating multidisciplinary team, primary preventive strategies and nationwide diabetic care programme are proposed steps to deal this impending pandemic [18].

Read More About Lupine Publishers Journal of Urology & Nephrology Please Click on Below Link:

Wednesday 26 April 2023

Lupine Publishers| Effect of Brick Forming Load on Mechanical Properties of Fly-Ash Bricks

 Lupine Publishers| Journal of Civil Engineering and its Architecture


Manufacturing of fly-ash bricks are the very useful alternatives of conventional burnt clay bricks. Manufacturing of clay bricks cause top soil removal, environmental pollution and health problems. To avoid all this environmental threats an attempt is made to manufacture of bricks using fly-ash, gypsum, sand and cement. Mainly fly-ash bricks are made by applying compressive load on the mold. In this research, the effect of brick forming load on the crushing load, water absorption and unit volume weight were studied. For this purpose bricks were prepared for different fly-ash (50% to 65% at 5% increments), gypsum (12% to 3% at 3% decrements), sand (28% to 22% at 2% decrements) and 10% cement. All ingredients were thoroughly mixed and then poured them to a mold of 9.5cm x 4.5cm x 2.75cm. Bricks were made by different forming load and mechanical properties were noted. This research suggested that it was possible to make good quality bricks using fly-ash, gypsum, sand and cement.

Keywords: Fly-ash; Gypsum; Sand; Cement; Brick forming load; Mechanical properties

Abbreviations: IS: Indian Standard


Fly-ash is a predominantly inorganic residue obtained from the flue gases of furnaces at pulverized coal power plants. Fly-ash is produced in a large scale in all over the world. Production of fly-ash in different countries [1] is shown in Figure 1.

Figure 1: Fly ash production (Mg per year) and utilization (%) in different countries.


Now it has become a concern to dispose it in a right manner. For this many researchers have tried to found out the way to use them. Fly-ash is now used in different sectors like brick making, agriculture, concrete production, embankments, road pavement, mineral filler in asphaltic concrete, mine reclamation etc. Recent review such as [2,3] presented the possible applications of fly-ash. Fly-ash is now used in agriculture to increase the land properties [4]. Fly-ash has cementious properties. Thus, it has been used in making concrete [5]. Now fly-ash is disposed in the form of bricks. These bricks are made commercially in many countries like United Kingdom, Germany and India. Many solidifying agents are used in production of fly-ash bricks like lime [6], slag [7,8], dextrin [9] and gypsum [10,11]. Several numbers of patents on the use of fly-ash-lime mixures to make unfired bricks [12-15]. Gypsum is an important by-product of fertilizer industry and causes serious environmental problem [16]. The strength of fly ash-lime-gypsum (FaL-G) bricks and hollow blocks increased at a faster rate in initial days of curing and subsequently at a relatively lower rate. It was observed that the hot water curing leads to a greater degree of hardening and higher strength. Water absorption increases with increased fly ash content and it decreases with an increase in the density of FaL-G bricks and hollow blocks [17]. The strength of concrete increased with increasing amount of fly ash up to an optimum value and decreased with further addition of fly ash. The optimum value of fly ash for the test groups is about 40% of cement. Fly ash/cement ratio is an important factor determining the efficiency of fly ash [18]. The phenomenon of bond development between the fly ash-lime-gypsum (FaL-G) brick and the mortar. The morphological and microstructure studies of the brick-mortar interfaces clearly proved the chemical bond formation at the FaL-G brick-mortar interface [19]. The effect of incorporating various additives (i.e. cured resin, pulverized stone, pulverized plaster, and glass fibers) and two drying method (air and microwave) on compressive strength of gypsum products. Microwave drying for 5 minutes could fasten the drying time and permit early manipulation of plaster and stone models [20]. The addition of fly ash enhanced the quality of the brick, although for restoration purposes if too much fly ash (P10 wt.%) is added, this can spoil the aesthetic appearance of the buildings being restored, due to excessive color differences [21]. The replacement of raw materials of clay by fly ash to make fired bricks is an effectively measure of saving land and decreasing pollution. The sintering temperature of bricks with high replacing ratio of clay by fly ash was about 1050C, which was 50-100C higher than that of fired clay bricks. The fired bricks were of high compressive strength, no cracking, low water absorption, high fastness to efflorescence, no frost and high resistance to frost-melting [22]. A technique for producing concrete bricks and paving blocks using C&D wastes as recycled aggregates. The replacement of coarse and fine natural aggregates by recycled aggregates at the levels of 25% and 50% had little effect on the compressive strength of the bricks and blocks, but higher levels of replacement reduced the compressive strength [23]. The investigation of industrial wastes produced by phosphoric acid plants and boron concentrators was used in light brick production. The environmental need to utilize wastes that would be hazardous otherwise. The economy of possible use of these wastes is also of importance since the disposal of the wastes [24]. Fly-ash-gypsum bricks are used as a lightweight, heavy strength and low cost bricks. Reaction of gypsum are taken place in the presence of water. By the presence of water it forms crystalline material which is not strong enough to bear a good compressive strength but uses as a finishing materials. In the past fly-ash was released to environment. Fly ash is used as pozzolan to produce cement. Fly-ash with gypsum is made a tough material having good finishing.

Experimental Programme

Materials used

Fly-ash: Fly ash used in this research was collected from Noapara, Jessore which is imported from India. Specific gravity of fly-ash was 2.10. The chemical compositions of fly ash in India [25] are indicated in Table 1.

Table 1: Chemical composition of fly ash in India.


Gypsum: Chemically known as “Calcium sulphate hydrate”. This material is non-toxic and don’t create any harmful effect on the human body, environment, plant lifes and animals. Gypsum used in this research was collected from Noapara, Jessore. Specific gravity of gypsum was 2.34. The chemical compositions of natural gypsum [10] is indicated in Table 2.

Table 2: Chemical composition of natural gypsum.


aLoss of ignition at 950 °C

bLoss of ignition at 550 °C

Sand: Locally available sand were used in this study. The specific gravity of sand was 2.78 and fineness modulus was 2.34.

Cement: Cement is a binder, a substance used for construction that sets, hardens and adheres to other materials, binding them together. Ordinary Portland Cement was used in this study. The physical properties used are given in Table 3.

Table 3: Physical properties of ordinary Portland cement.


Proportion and mixing of raw materials: Different proportion are used to cast fly-ash bricks. Materials are used as a percentage of the volume of the mold. Percentage of materials required for fly-ash bricks and brick no. for each proportion in different curing process and curing period Table 4.

Table 4: Percentage of materials required for fly-ash bricks and brick no. for each proportion in different curing process and curing period.


The amount of ingredients was weighted then mixed thoroughly in a dry state. When the colour of the mixed was seemed to uniform then water was added. After addition of the required quantity of water the mixture was thoroughly mixed in a pan. The water content used in this study was 80ml. The mixture was again thoroughly mixed until the mixture attained a uniform consistency.

Preparation of mortar blocks

A brick mold of size 9.5cm x 4.5cm x 2.75cm was used in this study. Then the mortar was placed on the mold and compacted using digitec concrete compression machine. The load was applied with average time of 15 seconds to 20 seconds. Then the excess mortar was hand finished. Nine specimens were prepared for each proportion. After that the brick forming load from the screen of the digitec concrete compression machine was recorded.

Curing of brick sample: The brick sample was taken out from the mold after 10 minutes. After removal from the molds, the brick samples were kept for air drying for 2 days. After sufficient strength was gained some of these bricks were transferred to water for 14 days and others were kept in air.

Method of testing: Poping out from the water bowl after 14 days curing, bricks were tested for compressive strength using digitec concrete compression machine. Compressive strength and water absorption test were conducted by following IS:3495 [26] and unit volume weight was conducted using literature.

Results and Discussion

Effect of brick forming load on crushing load

Air curing: Table 5 gives the information of forming and crushing load on water curing fly-ash bricks while Figure 2 presents the graphical representation of table 5. In Figure 2, crushing load is experienced upward in the first and gradually decreasing to the last. On the other hand forming load is gradually upward. Brick No. A3 gives the highest crushing value from all the available bricks which is marked in the Table 5 while C1 shows lowest crushing value.

Table 5: Crushing Load (kN) for air curing fly-ash bricks.


Water curing: Table 6 illustrates the forming load as well as crushing of fly-ash bricks of water curing of 12 bricks while Figure 3 represent the graphical demonstration of Table 6. Figure 3 shows a variety of deflections in crushing load of fly-ash bricks. Brick No. A3 gives the maximum crushing value i.e., 62.5kN and D5 shows the lowest crushing value of about 31.28kN shown in Table 6. Both values are highlighted to visualize easily with graphical representation.

Figure 2: Variation of forming and crushing load for air curing fly ash bricks.


Figure 3: Variation of forming load and crushing load for water curing fly-ash bricks.


Table 6: Crushing Load (kN) for water curing fly-ash bricks.


Table 7: Forming load on water absorption of fly-ash bricks.


Effect of brick forming load on water absorption: Table 7 depicts the variation of water absorption in accordance with the brick forming load in a tabular format and with the help of these data a graph was plotted to easy visualization (Figure 4). Marked B9 and C7 shows lowest and highest water absorption respectively. The bar diagram shows almost same variations which is indicated in the Figure 4.

Figure 4: Variation of water absorption with respect to forming load of fly-ash bricks.


Effect of brick forming load on unit volume weight: Experimental data on conducting research on fly-ash bricks have been illustrated in a table format in Table 8 and a bar graph (Figure 5) was used to show the variation unit volume weight with the brick forming load. Though forming loads show a variations but unit volume weight seems like a plain straight.

Table 8: Forming load on unit volume weight of fly-ash bricks.


Figure 5: Variation of unit volume weight with respect to brick forming load of fly-ash bricks.



Usually, FA obtained high strength at the initial stage of the formation of fly ash bricks while FA need long term hydration for the FA. In this study, it is found that crushing load for the water curing is higher at the brick no. of A6 shown in the Table 6. For considering the air curing into account, and displayed maximum crushing load for the brick A3 shown in Table 5 and by bar diagram in Figure 2. The maximum crushing load for air and water curing for fly-ash bricks were 76 and 62.5kN respectively while minimum crushing load were 41.25 and 31.28kN for air and water curing respectively. By performing the comparison between air and water curing, an interesting outcome is found that crushing load for air is greater than the crushing load for water curing. It may be happened due to initial hydration effect of fly ash.

By taking water absorption, it is shown in Table 7 along with the Figure 4 that B9 and C7 gives the maximum and minimum water absorption respectively. Looking to the other bricks demonstrates almost same fluctuations of water absorption. Almost same results were found also in the unit weight of the fly ash bricks in which the results (Figure 5) displays the same height at the forming load.

By doing the study, it may be concluded that proportion for brick “A” is quite good rather than other bricks. More research should be conducted on fly ash bricks to attain more accurate results and relationship.

Read More About Lupine Publishers Journal of Civil Engineering and its Architecture Please Click on Below Link:

Monday 24 April 2023

Lupine Publishers| Atypical Manifestation of a Tooth Crack

Lupine Publishers| Journal of  Dentistry and Oral Health Care


A patient presented with severe pain in the area of teeth #2 and #31. Prior to seeking dental care, the pain had been so severe together with other clinical manifestations that the patient sought medical attention for a heart attack. After elimination of the occurrence of a m.i., the pain was thought to be dental in origin and dental care was sought. No carious lesions or endodontic problems were found upon radiographic examination. However, careful oral examination revealed the presence of a crack transcending tooth #31. Following tooth extraction and immediate implant placement, no further pain was experienced by the patient.


Splits or fractures are the third most common cause of tooth loss in industrialized countries, primarily affecting maxillary molars and premolars, and mandibular molars [1]. However, most clinicians would agree that tooth cracks are difficult to diagnose [2- 4]. Although pain on biting is often considered the most reliable diagnosis for a tooth with a visible crack [5], the most common symptom of a cracked tooth is pain to cold [3]. Further, pain and other symptoms associated with tooth cracks can manifest in different ways, often in areas remote from the actual crack [1]. Interestingly, it has been reported that pain associated with tooth cracks are less likely in teeth with stained cracks or exposed roots, or in non-Hispanic whites [4]. This paper discusses the atypical pain caused by a root fracture in a molar tooth and which manifested in unexpected and misleading ways.

Patient Consultation

A 50 y.o. male patient in good general health presented with pain in the area of teeth #2 and #31. The patient was a dentist and reported that he had experienced severe pain on the left side of his face, with pain extending down his left arm together with heart palpitations and elevated blood pressure. Suspecting a M.I., the patient sought medical care but a visit to the Emergency Room together with blood tests indicated that the patient was not experiencing a heart attack. The pain was ascribed to dental issues on the right side of the face. However, the patient reported no pain on biting or sensitivity to cold.

Clinical Examination

Radiographic examination of the patient, (Figure 1) indicated no carious lesions, sepsis or other issues with his dentition. However, careful intra-oral examination of the teeth indicated the presence of a crack on the distal surface of Tooth #31, (Figure 2). The crack appeared to have initiated from an apparently defective amalgam restoration, (Figure 3), and descended vertically to the apex of the tooth, (Figure 4). This conclusion appears to be justified because the literature indicates that a major predisposing factor to tooth fracture are mesio-occluso-distal restorations with mandibular first molar teeth being particularly affected [6]. Interestingly, the presence of calculus was noted in the buccal enamel and there are indications that this deposit caused widening of the enamel crack. No defects or lesions were noted in any other maxillary or mandibular teeth.

Figure 1: Radiograph of patient’s teeth.


Figure 2: Intra-oral photograph of affected tooth.


Figure 3: Intra-oral photograph of the affected tooth.


Figure 4: Crack on the distal aspect of tooth #2.


Treatment Regimen

In consultation with the patient, it was decided that the affected tooth could not be salvaged, and it was extracted under local anesthesia. Because the extraction site was infection-free, the periodontal condition was satisfactory, and the bone was solid and well-vascularized, an immediate implant was placed, (Figure 5).

Figure 5: Immediate implant placed following extraction.



After extraction of tooth #31 and resolution of local anesthesia, the pain was immediately eliminated. Satisfactory healing and osseo-integration are projected for the affected area.


Cracks in teeth weaken them and pain from cracked teeth can be felt in areas remoted from the affected tooth. What was unusual in the present case is the pain was experienced on the other side of the mouth from the affected tooth and intensified to the point that the patient suspected a myocardial infarction. Although tooth crack-induced pain often can be experienced in areas remote from the affected tooth, the existence of pain, so severe that it mimicked a heart attack, and occurring on the other side of the mouth was unusual. This particular case reinforces the need for clinicians to carefully examine all facets of the dentition of patients presenting with oral pain. Cracks in enamel do occur and, as in the present case, may originate from a defective restoration. However, crack progression to the tooth apex and sudden, sharp onset of pain is unusual. Even more unexpected is that the pain was experienced on the opposite jaw to the affected tooth.

Read More About Lupine Publishers Journal of Dentistry and Oral Health Care Please Click on Below Link

Saturday 22 April 2023

Lupine Publishers | Impact of The Nurses on Maintaining Oral Health in Institutionalized Elderly

 Lupine Publishers | Journal of Nursing & Health Care


Dental and oral care are important for institutionalized elderly because oral diseases can have a negative impact not only on quality of life but also on general health. Maintaining adequate oral hygiene among the institutionalized elderly is most important, especially on patients that need help for basic or additional oral and dental care. Most often responsible for maintaining oral hygiene are the persons responsible for long-term care of the institutionalized elderly - nurses and paramedics. The education of stuff responsible for institutionalized elderly includes the usage of appropriate lectures with adequate audiovisual effects, appropriate presentations and exercises and discussions among the participants. For adequate dental care of the institutionalized elderly, it is necessary for the elderly, as well as the staff responsible for their care, to be highly aware and motivated to pay enough attention to oral health and hygiene, as well as wearing dentures. Oral health programs and protocols can also be used to educate institutionalized elderly, as well as non-dental staff caring for the institutionalized elderly such as GPs, nurses, nutritionists, and social workers, to change the approach to oral health and its promotion. When the patient is unable to maintain oral hygiene on his / her own, it is necessary to educate the family members and the staff responsible for them regarding their knowledge and training in maintaining oral hygiene.

Keywords:Institutionalized Elderly; Long Term Care Institution; Oral Health; Oral Hygiene


The establishment of a protocol for the promotion of oral health and hygiene among institutionalized elderly should be of specific interest not only to dentists, but also to all professionals involved in the care of these people. Institutionalized people have a strong need for oral care and treatment, although they are extremely rarely aware about it and very rarely aware for the need. The institutions for long-term care of the elderly meet most of the medical, social and personal needs of those elderly who cannot take care of themselves [1]. Dental and oral care is important for institutionalized older people because oral diseases can have a negative impact not only on quality of life but also on general health. Also some diseases can influence on the oral health. Characteristics of the oral health among institutionalized elderly are presence of a small number of remaining teeth, problems with teeth and periodontal tissues and xerostomia. These conditions can greatly affect the feeding process, the diet and food selection, the elderly do not take essential nutrients and are prone to malnutrition and hypovitaminosis, psychological state and interpersonal communication [2]. Maintaining adequate oral hygiene among the institutionalized elderly is most important, especially on patients that need help for basic or additional oral care. Stuff primarily responsible for caring for institutionalized seniors need to be aware about the fact that oral diseases are more complex over time [3]. Main goals for adequate maintaining of oral hygiene among institutionalized elderly people are in context of:

a) Regular removal of dental from teeth and prosthetic devices

b) Cleansing of the oral mucosa from debris

c) Regular dental check-ups

d) Constant oral hydration due to the high prevalence of xerostomia

According to this, there is necessary for development of the high-quality prevention program.

Influence of nurses in maintaining oral health in institutionalized elderly

Due to the fact that there are not always opportunities for obtaining adequate dental care in the institutions by a dentist, the people responsible for their care are ideal candidates for implementation of these activities. The staff responsible for institutionalized elderly plays a huge role in the dental care of the institutionalized elderly within the institution. This is due to the fact that they come into direct contact with the elderly and know their needs and opportunities for performing daily oral hygiene [4]. Elderly population institutionalized in long-term care institutions mainly has inadequate or insufficient oral health and hygiene. This condition is especially characteristic of people who need help to maintain adequate oral hygiene. Activities for regular maintenance of oral hygiene should be related to the use of appropriate toothbrushes, manual or electric, using additional techniques for maintaining oral hygiene, toothpaste, which should be fluoridated as with chlorhexidine-containing agents. For proper oral hydration it is necessary to use mouthwashes or gels [5]. The activities for adequate oral hygiene can be undertaken by the staff responsible for the care of the elderly, by the elderly themselves or by both groups. Maintaining adequate oral hygiene among institutionalized elderly is main responsibility of the staff for longterm care of the institutionalized elderly - nurses and paramedics. The need for training related for adequate oral hygiene activities for institutionalized elderly of this stuff is necessary. One of the reasons why nurses are avoiding activities related to oral care for the elderly is associated with insufficient recognition of oral hygiene proprieties among institutionalized elderly. Nurses have deficient knowledge about oral hygiene and oral diseases. Problems related to maintaining oral hygiene among caregivers are:

a) Shortage of time

b) Inadequate knowledge about techniques for maintaining oral hygiene

c) Non-communicative and inappropriate patients [6].

The training of these staff can improve the quality of oral hygiene among institutionalized elderly. Guidelines for educational programs for improving oral health and hygiene for caregivers are targeted to:

a) Importance of daily maintenance of oral hygiene among institutionalized elderly.

b) Theoretical bases and practical improvement of the techniques for maintaining oral hygiene among institutionalized elderly.

c) Recognition of clinical signs and symptoms of the most common oral diseases [6]

According to these facts, educational programs must include activities mainly targeted to:

a) oral health evaluation of institutionalized elderly

b) education of staff for maintain oral hygiene

c) education of institutionalized elderly

d) prevention of oral diseases [7].

The role and attitude of long-term care staff can influence on understanding and improving of oral health. It can be easily noticed that the management of the institutions for long-term care of the elderly indicate that oral health and hygiene is better than it is in reality [8]. The education of stuff responsible for institutionalized elderly includes the use of appropriate lectures with adequate audiovisual effects, appropriate presentations and exercises and discussions among the participants. Also, it is important to adapt the educational program according to their prior knowledge.

The goals of the educational program of the professionals responsible for the care of the elderly are aimed to

a) Obtaining information about oral conditions and diseases as well as the possibilities for their prevention

b) The importance of regular maintenance of oral hygiene, as well as the negative effects of not maintaining oral hygiene on oral and general health

c) The impact of xerostomia on oral health, nutrition and general health

d) Detection of changes in the oral mucosa caused by improperly dentures

e) The importance of tooth replacement especially in chewing and nutrition

f) Introduction to the positive effects of the use of fluoride toothpastes and mouthwashes [9].

Working with the elderly is not just a waste of time and it is always necessary to consider their needs as well as their health. Based on the high percentage of institutionalized people who are medically compromised, it is necessary for the staff to be familiar with the characteristics of their oral health and oral hygiene depending on the present diseases. Patients with mobility impairment or inability to understand the instructions for maintaining oral hygiene need to be properly cared by the staff responsible for them. A special problem are people with cerebrovascular diseases or arthritis, in which there is a predominantly reduced manual activities, is necessary if they are able to be trained for independent oral hygiene using a regular toothbrush. People with higher physical disabilities are among those who need help with regular oral hygiene. Professionals responsible for caring of institutionalized elderly in many cases need to make some adjustments to the toothbrushes to facilitate oral hygiene. Such adaptations are increasing the length or changing the angulation of the brush handle. Today, some manufacturers of products for maintaining oral hygiene in daily production have released such brushes. Oral hygiene activities can be performed in the baths from the hospital rooms or in the beds among the patients with disabilities. It is best for these patients to be in a sitting position. The importance of the training of this type of staff is especially important in the cases when the activities for maintenance of oral hygiene among the institutionalized elderly people who are „tied to the bed”. In such persons, the position in which the person should be is the lateral decubitus position [10]. Brushing the teeth of people who need help is best to be done at bedtime, but due to the shortage of staff in night shifts, brushing their teeth at least once a day, sometime after breakfast or lunch is also satisfactory. The average time it takes for a patient is 2 minutes, with small variations in people who have small number of natural teeth. The use of an electric brush in such persons is important in saving both the time and the physical condition of the persons responsible for maintaining oral hygiene. Additionally, it is necessary to use 0.12% chlorhexidine solution in patients who don’t have problems with swallowing and spitting [11].

Staff which is taking care of the oral hygiene of institutionalized elderly people needs to be trained for hydratation of the oral mucosa of people with severe xerostomia who are unable to take care of themselves. It can be used a gauze (preferably sterile) that is immersed in saline, and their lips should be coated with neutral cream. People who have xerostomia are also advised to use sugar-free chewing gum or gums with artificial sweeteners, nonalcoholic solutions and gels, and in the most severe cases after the recommendation of dentist artificial saliva can be used [3]. Caries reduction and the number of extracted teeth as a result of caries, reducing the number of teeth lost due to periodontal disease, reducing the number of people who use tobacco due to its side effects, reducing the number of toothless individuals, increasing in the number of natural teeth, as well as increasing of the percentage of persons who meet the criterion of optimal oral health are the longterm aims of geriatric preventive dental medicine. Guidelines for regular screening for oral cancer and xerostomia among the elderly aged 65-74 are also provided in the most developed countries [12]. For adequate dental care of the institutionalized elderly, it is necessary for the elderly, as well as the staff responsible for their care, to be highly aware and motivated to pay enough attention to oral health and hygiene, as well as wearing dentures. Activating the elderly in performing various activities for maintaining oral hygiene is aimed to restore their self-confidence, as well as to enable physical and muscular activity and coordination. This is also an important role of the nurses in the long-term care institutions.

The basic activities for implementation of oral health and hygiene protocols among institutionalized elderly aimed for solving the following problems

a) Improving and maintaining adequate dental hygiene, by brushing all teeth sides with the use of fluoride paste. Mobile prosthodontic appliances, before undertaking such activities, it is necessary to be removed from the mouth. This is based on fact that fluoride dental pastes have been scientifically proven to be effective in reducing coronary and root caries. Institutionalized elderly with mobile prosthetic appliances should know that prostheses need to be removed from the mouth overnight. If there are financial possibilities, additional chemical solutions can be used for additional denture hygiene.

b) Rinsing the oral mucosa with chlorhexidine. Daily rinsing of the mouth with this solution for at least one minute is recommended. Usage of chlorhexidine is due to its scientifically proven role against bacteria.

c) Solving the xerostomia. It is necessary to educate the staff who takes care for the institutionalized elderly as well as the institutionalized elderly for proper nutrition, rich with fresh vegetables and fruits, rinsing with mouthwashes that can regulate the xerostomia [6].

Oral health programs and protocols can also be used for education of institutionalized elderly, as well as non-dental staff caring for the elderly such as GPs, nurses, nutritionists, and social workers, to change the approach to oral health and its promotion. The knowledge, attitudes and habits they will acquire and develop can have long-term implications for the oral health of the elderly.

Most often the goals of such prevention programs are:

a) Understanding the importance of reducing carbohydrate intake between meals, due to the fact on reducing the prevalence of dental caries

b) Understanding the meaning of having bigger number of natural teeth in the mouth

c) Increasing the percentage of the elderly population that makes regular dental check-ups

d) Ideal or optimal oral health is imperative for institutionalized elderly. The need for the staff caring for the institutionalized elderly to get acquainted with the optimal oral health and to understand the role of the oral health and hygiene.

And maybe the most important is when the patient is unable to maintain oral hygiene on his / her own, there is necessary to educate the staff responsible for them regarding their knowledge and training in maintaining oral hygiene. Institutionalized elderly people have a lot of oral changes and disorders such as: caries and periodontal disease, xerostomia, inadequate restorations, bruxism, tooth loss, as well as other general factors that may affect the oral health of these individuals. Therefore, when performing dental interventions, during each visit before the intervention, it is necessary to go through the medical history again, due to the possibilities of changes in the health condition of the elderly [12]. Psychological and economic moments influencing poor oral health and hygiene can have a negative effect on quality of life should be also taken as the basis of any oral health improvement protocol. Hence the importance of a multidisciplinary approach is to meet the health needs of the elderly.


Based on the fact that the oral health and hygiene among institutionalized elderly are poor and inadequate, a proper protocol for education of the staff responsible for them is more than needed. Educational activities of this protocol should be based on the evidence-based facts and on their prior knowledge. The staff must be aware and should perform activities targeted to improve the oral health and hygiene among institutionalized elderly.

Read More About Lupine Publishers Journal of Nursing Please Click on Below Link:

Friday 21 April 2023

Lupine Publishers | Gender and Two Major Traumas of 20th and 21st Century: War and Breast Cancer

 Lupine Publishers | Journal of Clinical & Community Medicine

Review Article

’’Children here find refuge in their hopes to die. The fact that death is equated to life is horrifying me. How are we going to deal with this generation in the future, how could we talk about life?’’ (Message from Nadera Shalhoub-Kevorkian, working in the Palestinian Balata camp during the Israeli raids of March 2002).

’’ I carressed my left breast, I rolled the lump under my fingers and I told myself it was at the exact same place where my mother, thirty-seven years earlier, had sewed up the yellow star. Finally, it had hit us. The much hoped for punishment was here. Would the dead be resurrected?’’ (Ania Francos, p. 47).

The first quote is from an email message I received from Nadera, an extraordinary woman I met in Istanbul in September 2001, who works with and for women in Israel and Palestine. It very much sums up the place we have reached in our present world: children in the Middle East and in many parts of the world, hope to die, the world offers them only despair, injustices are the order of the day… How can it go on like this? How can we go on living in such a world?

The second one is by Ania Francos, a Jewish woman suffering from breast cancer who ultimately died from it. Throughout her book, Sauve-toi Lola, she compares her trial with breast cancer to the ordeal her family went through with the Holocaust.

In both quotes, we find History repeating itself, as if human beings had so little imaginations and resourceful creativity, that the only response they have to violence is more violence and war which in turn brings more violence and bloodshed.

In this article I would like to make the connection between two major traumas of 20th and 21st century: war and breast cancer. Throughout my book, Cancer Journeys, I draw consistently on the same parallel, equating cancer and war. Having suffered in my body through the war in Lebanon and through breast cancer, having witnessed the agony and death of loved ones during the bombing of the city, and at the bedside of friends succumbing to cancer, I began to get the feeling that the two were connected.

Close analysis has indeed produced a number of similarities.

I was in terrific pain when I woke up after my mastectomy, and was given what are commonly known as “pain killers.” There is an uncannily frequent use in medicine of words that connote violence.

In the treatment of cancer, military metaphors and violent images abound. The body is ‘attacked’ by poisons in chemotherapy, or “nuked” as some say; patients undergo “radiation”; surgical intervention is called an “operation.”

But there’s more: chemotherapy as we know it was discovered during World War II, “thanks” if I dare say, to the observed effects of nerve gas. After an explosion of mustard gas bomb containing nitrogen in a submarine, it was observed that those on board who had been exposed were all deficient in white blood cells. Since leukaemia features a surplus of white blood cells, it was thought that nitrogen could halt the proliferation of the undesired cells. And thus chemotherapy was born.

The presence of war symbolism in cancer made me hate the disease all the more. My entire being, mind, body and spirit, are in revolt against this violence-laden aspect of cancer, and all other aspects as well, but this one in particular. I detest violence, and I sincerely yearn for the day when there will be gentler, more peaceful treatments for this disease.

War and the aggressive fight against cancer serve only to transfer the problem, placing emphasis on the symptoms without getting to the origin of the evil. War and “battling” cancer are not intrinsically necessary, but rather represent a failure to deal with problems in alternative ways, to resolve disorder in a situation that is out of control. Wars of mass destruction and the aggressive fight against cancer are the touchstones of the 20th century, of a world that contradiction and conflict have reduced to tatters.

Lebanon has had its share of war and destruction in the last decades, between 1975 and 1992, it was torn apart by a civil war fed by many countries worldwide that cashed in with sales of weapons to various militias, sometimes to both sides, regardless of alliance. Some militias in exchange for money and weapons buried nuclear waste products in various parts of Lebanon. The Lebanese population is now paying the price with a rise in cancers of all kinds. Cancers of the mind and heavy depressions plague the youth that have had to deal with the war. The wounds and scars are visible. It will take a long time for the country and its people to heal. And then again two summers ago, Israel hit again in response to Hezbollah capturing of two of their soldiers and managed to destroy the whole infrastructure of the country, polluting the air, sea and land, leaving behind million of fragmentation bombs. It will take years again for Lebanon to come out of this new disaster!

The hairdresser who came to do Mother’s hair, when I was visiting her in Beirut in 1995 while recovering from breast cancer, told me he was used to seeing hair that turned out like mine due to cancer treatments. It was radiation, particularly, that made it curly in that strange, electric way. In Arabic he said to me that kahraba (electricity) caused kahraba. I didn’t believe it when people had told me hair reacted differently to these treatments, hair that used to be curly became straight and straight hair turned curly. I thought they were old wives tales. And I could tell people thought I was making it up when I told them my hair was not curly like that before.

The Beirut hairdresser told me there were two kinds of cancer: the feminine and the masculine, the feminine was much more virulent than the masculine. It was very aggressive, a real killer. I pondered over his remark: gender differences applied to illness. I had always been interested in gender differences. It was the subject of one of my books. In it I analyzed how gender differences were closely linked to war. Sexuality and war were interconnected. This popular image of cancer reinforced my analysis in showing that the fear men have of women was manifested even in their portrayal of disease. The female brand of a disease (is there any such thing scientifically?) was much more dangerous than the male one? It killed faster. Where did the idea come from?

Cancer victims enter, or are pushed into, a space which I have called “a zone of illness,” where they lose control over their lives and their freedom of choice; and this state, too, resembles that of concentration camp victims. Patients enter an organization conceived as a rational machine, an industrial machine made to treat the disease, one whose discourse is not to give a conscious choice to the patient but to orient her/him in a programmed direction. The patient is not warned about many of the consequences of the treatment she/he will be subjected to, but discovers them on the way: castrations, mutilations, loss of certain limbs’ use, certain pains, threat of other treatment-induced cancers, weakness, debilitation, fragility, death, danger. They are accompanied by other consequences often warned about but minimized as “secondary effects” while actually so central: baldness, nausea, pain, muscle weakening, heart muscle damage, loss of appetite, burns, tiredness.

The importance of incorporating a discourse on sexuality when formulating a revolutionary feminist theory became very evident as I started analyzing and writing about the Lebanese war. The war itself seemed closely connected with the way people perceived and acted out their sense of love and power, as well as their sense of relationship to their partners, to the family and to the general society. Usually the argument has been made that women’s issues detract from the war effort, that wars create such conditions of despair that, within this context, women’s issues are unimportant, and if the “right” side in a war were to win, women’s problems would automatically be solved. I argued the reverse. I suggested that sexuality was centrally involved in motivations to war, and if women’s issues were dealt with from the beginning, wars might be avoided, and revolutionary struggles and movements for liberation would take on a very different path. Justice cannot be won in the midst of injustice. All these levels are interwoven.

In my book on Sexuality and War, I analyzed how the whole range of oppression women suffered from in the Middle East: forced marriage, virginity, and the codes of honour, forced confinement, the veil, polygamy, repudiation, beating, lack of freedom and the denial of the possibility to achieve their aims and desires in life--practices, some of which motivated me to run away from Lebanon at the age of twenty-two--were closely connected to the internal war in Lebanon (I was not referring to the Israeli and Syrian occupations, nor to the foreign interferences). There are at least seventeen political parties--with many subdivisions—that were fighting each other in Lebanon. During the war, each of these parties had different interests; each tried to dominate a small piece of territory and impose its vision of Lebanon onto that territory. Each group tried to dominate the others largely through the control of women in a way I tried to formulate. One of the codes of Arab tribes is sharaf (honour) which also means the preservation of girls’ virginity, to ensure that the women are kept exclusively for the men of their tribe.

The means of conquest were given a value in proportion to their success. The gun, the machine-gun, the cannon--all masculine sexual symbols which are extensions of the phallus--were put forward and used to conquer and destroy. For Adam Farrar, there is a kind of jouissance --pleasure in a sexual sense, no equivalent word in English--in war:

One of the main features of the phenomenology of war is the unique intensity of experience. War experience is exactly the converse of alienation. In war, the elimination of all the norms of intersubjectivity produces, not alienation, but the most intense jouissance. The machining of events on the plane of intensity (to use the Deleuzian image), the form of desire, is utterly transformed. Power no longer consists in the capacity to redeem the warrants of communicative intersubjectivity. It consists in the ability of the spear, the sword, the gun, napalm, the bomb etc. to manifest ‘in a blast of sound and energy and light’ (or in another time, in the blood of a severed limb or a disembowelled body), the merest ‘wish flashing across your mind like a shadow’1.


1 Adam Farrar, “War, Machining Male Desire,” War/Masculinity (ed. Paul Patton, Ross Poole, Sydney: Intervention) p. 66.

Farrar continues, quoting an article by William Broyles in Esquire entitled “Why Men Love War,” that it is at some terrible level, for men, the closest thing to what childbirth is for women: the initiation into the power of life and death2.

In Arab society, most sexual relations are not built on pleasure, tenderness or love, but on reproduction, the preservation of girl’s virginity (so-called ‘honour’ of the family), the confinement and control of women for the increase in male prestige, and the overestimation of the penis. Many important studies by women and men in the last few years see a link between sexuality and national/international conflicts. In an article published in an important French review entitled Alternatives Non-Violentes, Jean-William Lapierre, well-known specialist on the subject, sees a real “deep connection between masculine predominance and the importance of war3.” According to him, most civilizations are based on conquest and war. “The importance of hunting, then of war in social existence, in economic resources, in cultural models (which valorise the warrior exploits), are at the roots of masculine domination and of women’s oppression4.” He explains how in socalled “modern” societies, politics, industry, business, are always a kind of war where one (mostly men, and sometimes women imitating men’s behaviour) must be energetic, aggressive, etc., to be powerful. It is not only capitalist societies which “carry war like clouds carry the storm, but productivism in all its forms, including the so-called ‘socialistic’ one. In all societies in which economy and politics require a spirit of competition (while its ethic exalts it) women are oppressed5.” And Bob Connell sees a relationship between masculinity, violence and war. He says that it is not by chance if the great majority of soldiers are men--of the 22 million people under arms in the world in 1976, 20 million of them were men. “Most of the police, most of the prison warders, and almost all the generals, admirals, bureaucrats and politicians who control the apparatus of coercion and collective violence. Most murderers are men. Almost all bandits, armed robbers, and muggers are men; all rapists, most domestic bashers; and most people involved in street brawls, riots and the like6.” But such connection should not be attributed to biology that would absolve masculine responsibility- -men’s violence associated to some human “destiny”--but rather to social and cultural factors.

The discussion of sexuality and its relationship to political and social conflicts is also silenced through women’s unquestioning adherence to dogmatic political systems of thinking. Many nationalist and leftist women felt that women should rally behind the already existing movements and ideologies. Yet in these movements, traditional morality often filters through dogmas, setting new barriers between women’s sense of obligation and their search for truth and freedom. Yolla Polity-Charara provides an incisive analysis of this problem as exemplified in Lebanese politics. According to her, many Lebanese women joined political parties thinking that the condition of women would change. But “how could it be possible with so many ideological differences and antagonisms, representing the whole range of political forces in Lebanon, not to be divergent on the details of women’s demands7.” According to Charara, the party and ideological loyalties made women loath to complain about their fate to other unknown women, and even more so to rivals. The militants among them, when conscious of the discrimination women faced, when they were not themselves token-women in the party, preferred to wash their dirty laundry within the family; they refused to question publicly the men of their party, to admit that their men were not the most advanced, the most egalitarian and the most revolutionary. Thus, in such a context, loyalty and siding with a group became more important than the issues themselves.

Betty Reardon explains how the patriarchal system is not only happy with dividing women along loyalty lines, but uses violence to train people into gender roles which reinforce the war system:

The fundamental willingness to use violence against others on which warfare depends is conditioned by early training and continuous socialization in patriarchal society. All are taught to respect authority, that is, fear violence... Boys and men are encouraged to become more fierce, more aggressive when they feel fear. Fear in men is channelled into aggression, in women into submission, for such behaviours are necessary to maintain patriarchal authoritarianism. Aggression and submission are also the core of the basic relations between men and women, accounting, many believe, for women’s toleration of male chauvinism. Some assert that these behaviours are the primary cause of all forceful exploitation, and account for perhaps the most significant common characteristic of sexism and the war system: rape8.

Issa Makhlouf in his book, Beirut or The Fascination with Death, talks and analyzes rape in the war of Lebanon, a subject no one before him had been willing to expose. He says that it is another facet of the Barbary, frequently practiced by militias during massacres and occurring almost everywhere on Lebanese soil.

The fixation of militias on sexual organs did not only hit women. Several male cadavers were discovered with their sex cut off and sometimes pushed into their mouths; the simulation of fellatio, generally repressed by morality, is very revealing as a rejection of moral codes. On the other hand, numerous mutilations were practiced on victims, dead or alive. In rape, all forms of violence are combined. All possibilities of death and pleasure are present. All dreams of domination are fulfilled. The victim of rape is the toy of all phantasms and ambitions. Rape is the place of all experimentations9.


2 2Ibid., p. 61.

3Lapierre, «Femmes: Une oppression millénaire.» Alternatives non-violentes: Femmes et violences 40 (Spring 1981) p. 21.


5Ibid., p. 22.

6Bob Connell, “Masculinity, Violence and War,” War/Masculinity, op. cit., p. 4.

7Yolla Polity Charara, “Women and Politics in Lebanon,” Third World, Second Sex (op. cit.) pp. 19-29.

8Reardon, op. cit., pp. 38-39.

Susan Brownmiller in Against Our Will has shown how rape is a conscious tactic of warfare10. Michel Foucault has written a great deal on the connection between death, sex, violence and male sexuality11. Wilhelm Reich has analyzed how repressed sexuality based on authoritarian family patterns is at the root of sadistic murders, perversions, psychological problems, social and political conflicts12. And Farrar notices that: “War is a paradigm of masculinist practices because its pre-eminent valuation of violence and destruction resonates throughout other male relationships: relationships to other cultures, to the environment and, particularly, to women. If the ‘masculinism’ of war is the explanation for its intractability, then we must follow this path to its conclusion, wherever that may be13.”

The whole system must be changed and rethought. To use Betty Reardon’s words:

What I am advocating here is a new world order value, reconciliation, and perhaps even forgiveness, not only of those who trespass against us, but primarily of ourselves. By understanding that no human being is totally incapable of the most reprehensible of human acts, or of the most selfless and noble, we open up the possibilities for change of cosmic dimensions. Essentially this realization is what lies at the base of the philosophy of nonviolence. It we are to move through a disarmed world to a truly non-violent one, to authentic peace and justice, we must come to terms with and accept the other in ourselves, be it our masculine or our feminine attributes or any of those traits and characteristics we have projected on enemies and criminals, or heroes and saints14.

And as Andrea Dworkin put it: “To transform the world we must transform the very substance of our erotic sensibilities and we must do so as consciously and as conscientiously as we do any act which involves our whole lives15.”

By sexual revolution, I mean one which starts at the personal level, with a transformation of attitudes towards one’s mate, family, sexuality, and society; specifically, a transformation of the traditional relations of domination and subordination which permeate interpersonal relationships, particularly those of sexual and familial intimacy. We need to develop an exchange of love, tenderness, equal sharing and recognition among people. This would create a more secure and solid basis for change in other spheres of life--political, economic, social, religious, and national, as they are often characterized by similar rapports of domination. As Elisabeth Badinter insightfully expressed:

Equality, which is taking place, gives birth to likeness which stops war. Each protagonist wanting to be the ‘whole’ of humanity, can better understand the Other who has become his/her double. The feelings which unite this couple of mutants can only change in nature. Strangeness disappears, replaced by ‘familiarity’. We may lose some passion and desire, but gain tenderness and complicity, the feelings which unite members of the same family: a mother to her child, a brother to his sister... At last, all those who have dropped their weapons16.

The similarities and differences between the ways women and men express and deal with violence and sexuality can lead us to a greater comprehension of the complexities in the relationship between the two and bring us to a solution: i.e. a new rapport between men/women, women/women, and men/men, relationships based on trust, recognition of the other, tenderness, equal sharing and love void of jealousy and possession. My contention--going along with the cherished vision of Feminists--that the personal is the political, changes in relationships traditionally based on domination, oppression and power games will inevitably bounce back on other spheres of life.


9 Issa Makhlouf, Beyrouth ou la fascination de la mort (Paris: La Passion, 1988) pp. 88-90.

10Susan Brownmiller, Against our Will: Men, Women and Rape (New York: Bantam, 1976).

11See in particular Michel Foucault, “Tales of Murder,” I, Pierre Rivière (Penguin, 1978).

12Wilheim Reich, L’irruption de la morale sexuelle (Paris: Payot, 1972, first published in German in 1932).

13Farrar, op. cit., p. 59.

14Betty Reardon, Sexism and the War System (New York/London: Teacher’s College/Columbia University, 1985) p. 94.

15Andrea Dworkin, Marx and Gandhi were Liberals: Feminism and the ‘Radical’ Left (CA: Frog in the Well, 1980) p. 6.

16Elisabeth Badinter, L’un est l’autre: Des relations entre hommes et femmes (Paris: Editions Odile Jacob, 1986) p. 245.

Examples from the Lebanese War Novels

I will quote two passages from two Lebanese war novels, and you can guess which one was written by the woman and which by the man:

And this city, what is it? A whore. Who could imagine a whore sleeping with a thousand men and continuing to live? The city receives a thousand bombs and continues its existence nonetheless. The city can be summarized by these bombs... When we had destroyed Beirut, we thought we had destroyed it... We had destroyed this city at last. But when the war was declared finished and the pictures of the incredible desolation of Beirut were broadcasted, we discovered we had not destroyed it. We had only opened a few breaches in its walls, without destroying it. For that, other wars would be necessary.

This city is like a great suffering being, too mad, too overcharged, broken now, gutted, and raped like those girls raped by thirty or forty militia men, and are now mad and in asylums because their families, Mediterranean to the end, would rather hide than cure...but how does one cure the memory? The city, like those girls, was raped...In the City, this center of all prostitutions, there is a lot of money and a lot of construction that will never be finished. Cement has mixed with the earth, and little by little has smothered most of the trees. If not all.

In these two images of Beirut, two opposing feelings are being expressed, two contrasting visions emerge. The first wants to get rid of the sinner, the whore, source of all evils, decadence, and the problems of modern existence. The total and violent destruction of the woman is seen as the only way out of an inextricable situation. The second feels sorry for the woman, the city, victim of rape, victim of man’s violence. Mediterranean customs are accused. Hypocrisy and the oppression of women are presented as the origin of madness and the destruction of the city.

The first quote is by a man, Elias Khoury, author of The Small Mountain (Minnesota: University of Minnesota Press, 1990)17, the second by a woman, Etel Adnan, author of Sitt Marie Rose (Sausalito, Calif.: Post-Apollo Press, 1982)18. This difference between a man and a woman’s visions of Beirut and their ways of expressing them was even more clearly defined one year during the war, as I watched women friends, determined to cross Beirut two or three times a week, pass through the demarcation line--the most desolate, depressing and often dangerous spot in the city. They went most of the time on foot, as only a few cars with special permission were allowed through. They were convinced that by this gesture, real as well as symbolic, Lebanon’s reunification would take place. They did this against all logic, under the ironic and sometimes admiring look of male companions19. Defying weapons, militias, political games, women friends told me how that site had become a meeting place where each morning they looked forward to seeing this friend or that one, walking steadfastly in the apocalyptic space of the museum passage (another name for the no man’s land dividing the city, because the museum is located there). They smiled at each other as they walked assuredly, conscious that their march was not an ordinary one, that their crossing was a daring act, important and vital to Lebanon’s survival.

I have chosen six novels about the war to illustrate the connections between sexuality, war, nationalism, feminism, violence, love and power as they relate to the body, the partner, the family, Marxism, religion, and pacifism. These novels do not necessarily represent the entire range of creative works about the war20. They were chosen for their significance in terms of the issues under discussion and for their availability in languages understandable to the Western reader. The works, originally written in Arabic or French, are by Lebanese women and men authors who have lived or are still living in Lebanon. All of the novels chosen are set in Beirut, in the context of the war. Days of Dust (Washington: Three Continents Press, 1983)21 by Halim Barakat and Death in Beirut (London: Heineman, 1976)22 by Tawfiq Awwad--works written before the war started in 1975--foreshadow the events. Even though the subject is treated differently, all of the writers show how war and violence have roots in sexuality and in the treatment of women in that part of the world. Most of the characters meet a tragic fate due to the war, but women are the principal victims of both political and social violence. For example, the heroine of Death in Beirut is seduced, raped, beaten, her face slashed, her ambitions smashed, as she tries to gain autonomy and education in the midst of her country’s social and political unrest. Zahra, in The Story of Zahra (London: Readers International, Quartet Books Limited, 1986)23 by Hanan El-Cheikh, who tries to find a way out of herself and of the civil war that has just erupted by having a sexual relationship with a sniper, becomes the target not only of his sexual weapon, but of his Kalashnikov as well. In the end, he kills her. In Etel Adnan’s novel Sitt Marie Rose, Marie Rose is struggling for social justice, Arab women’s liberation, and directs a school for the handicapped. She is put to death by Phalangist executioners who first torture her to get rid of their bad conscience. In House without Roots (Paris: Flammarion, 1985)24 by Andrée Chedid, Sybil dies from a sniper’s bullet at the point of possible reconciliation, the place where Kalya advanced trying to save Ammal and Myriam, one of them having been hit by the sniper’s death machine as they were starting a peace march. In Days of Dust, Pamela, trying to find herself by helping the refugees and protesting against American imperialism, loses herself in a no-exit relationship with the male protagonist. And in Elias Khoury’s novel The Small Mountain, the female characters are destroyed, disappear, or are trapped in disgustingly hateful marriage routines.

In addition to the relationship between war and sexuality, I examined the positive and negative actions and resolutions male and female characters took, the differences and similarities between male and female protagonists, between male and female authors, and between those writing in Arabic and in French. I also tried to assess the necessary changes Lebanon had to undergo to solve its tragedy and play, once again, the democratic role--melting pot of tolerance and freedom--it had in the region, and which is so much needed in that part of the world.

In this study, my hypothesis was verified and showed that although both female and male novels make the connection between sexuality and war, their ways of expressing it, and most of all the solutions implied, are quite different. Women writers paint the war and the relationships between women, men and their families in the darkest terms: sexuality is tied to women’s oppression and the restrictions put on their lives, the war brings destruction, despair and death. The female protagonists look for alternatives in non-violent active struggles such as peace marches, engagement in causes to help the oppressed and the dispossessed. At the same time, they seek for changes in their life styles and in their relationships with the men and families around them. Men writers also paint the war and men/women relationships in the bleakest terms, emphasizing the connection between the two. But their depression does not lead them to search for alternatives different from the historically accepted ones: heroism, revenge and violence as catharsis to men/women deplorable communication.


17 First written in Arabic (Al-Jabal al-Saghir, Beirut: Mu’assassat al-Abhath, 1977) also available in French (La petite montagne, Paris: Arléa, 1987).

18 First written in French (Sitt Marie-Rose, Paris: Des Femmes, 1977).

19 There are also men who, believing in the reunification of Lebanon, make the gesture, crossing the demarcation line, but it seemed to me they were fewer than women--perhaps because men risk more, are more often victims of kidnappings, assaults, murders. Men do it more in a spirit of duty or for professional interests.

20Cooke, op. cit.

21First written in Arabic (‘Awdat alta’ir ilal bahr, Beirut: Al’Mu’assassat Al-’Arabiya, 1969), also available in French (Le vaisseau reprend le large, Sherbrooke: Naaman, 1977).

22First written in Arabic (Tawaheen Beirut, Beirut: Dar al-Adab, 1972).

23First written in Arabic (Hikayat Zahra, Beirut: Al-Nahar, 1980), also available in French (Histoire de Zahra, Paris: Lattès, 1980).

24First written in French (La maison sans racines, Paris: Flammarion, 1985) also available in English (Return to Beirut, London: Serpent’s Tail, 1989).’

In both women’s and men’s writing, the war is used to break down the patriarchal system and the traditional order. The female protagonists do it through masochism while the male ones use cruelty and sadism. But such action/reaction leads nowhere because the use of war to free oneself from domination and oppression only reinforces the authoritarian order by reproducing the power structure with different colours.

Both women and men writers question God and the use of religion in war. Institutionalized religion is blamed explicitly, while faith and personal belief are praised implicitly and constitute-- more specifically in the women writers--strength and a way of overcoming war. So while male protagonists justify their fighting through religion or to show how it was used for imperialist purposes, the female ones draw their strength in helping the oppressed, sacrificing themselves for others welfare and in active non-violent struggles.

Both women and men writers seem to concur in showing female protagonists whose political outlook and actions are accompanied by similar ways in their personal lives, while male protagonists live double standards and hypocritical attitudes. In male authors, the female protagonists who are concerned and active politically also reject the traditional passive roles and refuse the taboos surrounding virginity and sexuality. They find themselves in situations where they are unable to live this conscious desire to be free because the men around them cannot cope with it. The irony is that these men voice beautiful statements concerning the need to achieve revolution in both domains: the private and the political, but when it comes to actualizing these theories in interpersonal relationships, it is as if they were paralyzed. It leads one to really doubt the effectiveness of what they advocate. Both male and female authors agree in portraying this difference between their male and female protagonists. To this characterization, women authors add an element not found in the men: their female protagonists often affirm themselves and live different life styles even if it means being marginalized, having to live in exile or being put to death.

Another major preoccupation of female and male writers is their outlook on multiculturalism and the question of roots, exile and pluralism mixed with violence and war, and how it is reflected in interpersonal relationships. Female authors tend to see mixity as something positive. Exile often means freedom. The search for roots can be an expression of nostalgia for one’s childhood or a need for security and love. Male authors tend to depict mixity as confrontation. Their search is for purity, mixity meaning dishonour. Multiculturalism increases their schizophrenia and makes them uneasy and depressed. Roots are a search for identity and exile is a terrible fate.

For example, Kalya in House Without Roots, raises questions about the significance of roots, and expresses the importance of grafting within her all the various roots and sensitivities of the cultures she is made of. She insists on the positive aspects of such hybridization and cosmopolitanism, and the enrichment, tolerance and openness it brings. These values are what Lebanon used to represent and what Kalya had come to seek. While Ramzy in Days of Dust, despairs at multiplicity which he associates with loss of identity, and sees it as one of the causes for the war. Ramzy is constantly split between East and West. It leads to schizophrenia and the inability to harmoniously integrate the various sides of his personality.

Intercultural and interconfessional marriages reflect the same outlook. Women authors depict female protagonists who live them harmoniously and with a great sense of achievement, commitment and possible solution to the war (even when they get killed because of it as with Marie Rose). Men authors show male protagonists split between a desire to achieve mixity on the political level and an impossibility to live it in their personal lives, even when they have voiced the importance of breaking down tradition on that level. Men authors also depict female protagonists better able to harmonize the personal with the political. Their failure to achieve true liberation stems not from their lack of action, but from the males’ inability to realize it with them.

Another notion implied by both female and male novels is androgyny. In this domain, there is less contrast between the two genders. Both women and men authors depict the negative and positive aspects of androgyny. Adnan refers to an androgynous mythical past to confront the male protagonists with their corrupted values. Chedid shows women characters who assume traits traditionally viewed as masculine. And Awwad also portrays women who, in order to free themselves, take on a masculine discourse and decide to engage in guerilla warfare. In these two authors however, the outcome is not positive. It does not engender life, nor is it a solution to war. And Barakat’s male protagonist who assumes both the female and male sides of his personality is not portrayed as having harmoniously integrated the two. He is constantly ill at ease and torn between aggressiveness and masochism, the male side being associated with victory and the female with defeat. The most positive portrayal of an androgynous character is in Khoury. One of the main protagonists is described as androgynous-looking and appears free from society’s restrictions. She is obviously a projection of who the central male character would like to be, how he imagines freedom and a way to reject war. This androgynouslooking character laughs, argues, moves freely, captivates the hero, runs towards the sea, and is unattainable because the man is too busy fighting “the revolution.” Why did the author choose to construct an androgynous-looking woman to represent freedom? Is he saying that woman and man are doomed to destroy each other and that only the androgynous can escape such fate? The novel as a whole does not seem to imply such a solution. Freedom is never chosen as the answer to men and women’s miseries. Instead, destruction appears as the ultimate response to human condition.

The question of poverty and class-consciousness related to war and women’s condition emphasizes women writers’ awareness, leading them to search for positive alternatives, while men writers use it to justify violence. Both male and female authors show the link between the fate of the dispossessed, their struggle to overcome it, women’s oppression and the war. Awwad paints a direct connection between the classes his female protagonists belong to and the degrees of abuse and violence they are subjected to. Chedid shows women characters whose private and political consciousness and commitment gives them real awareness and sensitivity to the condition of the poor and vice versa: watching the poor’s lives leads them to become socially committed and active for change in their personal as well as political lives. Similarly, Adnan portrays a female protagonist who is socially, politically and personally committed to women’s issues and to the fate of the poor, the dispossessed and the oppressed in general. As for Khoury, he often talks about “the war of the poor” to describe the link between oppression and war, and to justify a revenge of the dispossessed. The crowd, which invades the plush hotel district of Beirut, is coming from camps, ghettos and the poor areas of Lebanon. Khoury ironically recalls the name they walk on “France” (there is such a street in Beirut), to show it is also a revenge of the colonized against the colonizers.

Both male and female authors paint the disastrous consequences of virginity rites connected with the notions of honour, ownership of women and sexual relationships. It is these customs, which lead Al-Shaykh’s female protagonist to despair, madness and final death. She rejects them from the beginning and is revolted against male’s views of her body and sexuality. She would like to be freed from them and in control of her body and of her life. She uses the war to break down the taboos and to assert herself sexually. She finds out that the war is much stronger and more destructive than anything she has known before, and that the customs she hoped to get rid of through it are only temporarily shifted. They come back with greater strength and more destructive violence. And Adnan uses the narrator’s voice to comment on the frighteningly dangerous outcome of the codes of honour related to virginity, and how they reinforce tribal confessional sectarianship. As for Awwad, he shows the direct link between the customs of virginity, the exclusive propriety of women leading to violence and crimes at the foundation of a society built on divisions and an exclusive sense of propriety. In such a system, women are dominated, raped, led to suicide or killed by men themselves manipulated by political power. It is a vicious circle of power struggles in which women are the ultimate victims. And Barakat, through the interwoven stories of the Hyena and the Flying Dutchman, demonstrates the importance of the concept of virginity and the codes of honour related to women’s roles in society, with the strong implications of woman as earth, and Palestine as the ultimate woman.

In most of the novels under study, the codes of honour--related to virginity and to crimes meant to wash the family’s or tribe’s honour/pride in blood--are connected to rape, itself associated with death. Rape is linked to the notion of death. It is the absolute forbidden (specially on women of one’s tribe) therefore the absolute temptation of death (when inflicted on women of the other tribe). Men prove their masculinity through sexual acts of violence against women of the other clans. It, therefore, reinforces the system of the clan by making women vulnerable and in need of the men’s protection. In Al-Shaykh, the major female protagonist is subjected to rapes throughout her sexual life, which ends with death as the ultimate rape. In Awwad, the sexual act, in most of the men’s imagination and in their practice, is associated with rape. They seem unable to conceive of it differently; it is part of the system of power where they prove their masculinity and domination. Their way of conceiving sexuality often results in the death, suicide or annihilation of the female protagonist. And in Khoury, the wish of the central male protagonist is for the city/woman to be raped because she is like a prostitute and incarnates all the decadent moral values of industrial and modern life. But rape is not enough, it has to reach its limits into total destruction, and the devastation has to spread to other cities/women in the world, leading to annihilation and oblivion. While in Adnan, who also compares the city to a woman, she sees her rape/destruction as men’s ultimate cruelty, sadism and violence. She feels sorry for this woman/city and seeks for solutions in peaceful non-violent alternatives, even in the notion of self-sacrifice if that could help alleviate the hate and destruction. As for Barakat, the images used for the Arabs’ being defeated by Israel are of invasion, destruction and rape, taking place on the male protagonist’s body that is utterly frustrated and depressed because rendered powerless.

Sexual relations conceived in a system of power struggles and a structure of submission/domination will obviously result in rapes and in the abuse of women. Rapes are associated with unwanted pregnancies and abortions. In none of the war novels do we find conception, pregnancy and giving birth as something positive and happy. Both female and male authors seem to view life conception and creation as impossible and repulsive in the context of the war. The female protagonists are the ones who pay the price, because the male protagonists view women as having to assume the whole responsibility of contraception and pregnancy. The sexual act being, in most instances, one of rape and domination, women appear as mere objects of possession, vessels into which the men pour their anger and frustration, prolongation of the feelings and acts of war. Abortion is the direct result of rape, like destruction is the direct result of war. Life cannot be engendered in such a context.

The novels by both male and female authors end with the brutal death of some of the female protagonists. Their death is the direct result of the male protagonist’s violence, worse perpetrators of the war. Zahra and the child in her womb die from the sniper’s--and father of the child--bullet. A gang of young Christian militiamen executes Marie Rose. Young Sybil also dies from a sniper’s bullet. Zennoub is cruelly gang raped and, as a result, she commits suicide. While Miss Mary, who shows real solidarity for her female friends, and who tries to protect Tamima dies, shielding her from her brother’s cruel hand. In only one of the male author’s novel, one of the male protagonists dies. It is from fighting and one does not feel as sorry for him as with the female protagonists’ deaths. His death is the result of his own violence and not a cruelty inflicted from the outside as with the women. Even if violence coming from the oppressed holds a certain justification, the death of its victims does not stir our sympathy, as does the death of innocent victims.

In all of the studied novels, female and male authors concur in portraying their female protagonists as the ultimate victims. Where they disagree is in showing their responsibility and/or innocence. Khoury is the one who holds women responsible for their own victimization. His rage against the victims is so great that he calls for their total destruction. It is as if he were blaming the oppressed for being oppressed and calling for more oppression to get rid of oppression. Fanon’s view of violence as catharsis can be compared to Khoury’s call for total annihilation. They both call on negative, destructive means for the transformation of society. There is a similar element in Al-Shaykh’s novel where Zahra who goes to the sniper seeks a homeopathic cure against the war. The difference between Khoury and Al-Shaykh is that Zahra does it through masochism, thereby emphasizing her own victimization, while Khoury inflicts it through sadism, thereby increasing the cruelty and expressing a total lack of compassion for the victims. Finally, an obvious conclusion to this study is that the fear men have of women leads them to domination and war, while the fear women have of men’s violence leads them to masochistic submission or/and rejection of the men, and commitment to political, human and feminist causes. Both the female and male authors agree on this. For example, the sniper’s first reaction to Zahra is rape, as a way of proving his masculinity through control and domination. Fear is one of his primary motivations: fear of life, fear of women’s capacity to reproduce, to give birth, fascination with death and destruction. He does not want to assume the responsibility of the life he has engendered in Zahra’s womb, when he daily kills innocent victims and destroys life. In order to reestablish the chaos, daily drug and only meaning of his existence, he must kill her. And for Talal in The Small Mountain, fighting is like making love to a woman: it is frightening and never fulfilling. The author describes a group of fighters who have lost the meaning of life, a fraternity of men always afraid, attracted and repulsed by women and by war, who know only destruction in which they loose themselves. The hate and fear they feel for women becomes their ultimate motivation for war. Such fear is epitomized by the relationship the central character has with his wife. The author describes boredom and weariness in their relationship, thereby trying to justify the need for war to bring about necessary changes. The main character has an obvious fascination with death and destruction, which is closely related to his sense of pleasure. He is chained to his wife through habits he can only destroy through war. And he runs away from the other two women in his life, because they represent life and freedom, which he is unable to accept, busy as he is with destruction. It leads to an obsession with destruction, as if destroying the city and the woman it symbolizes brings in ultimate jouissance. And Zahra, afraid of the violence ripping her country apart, submits herself masochistically to one of its worse perpetrators, thereby hoping to overcome her fears. While the central women characters, in House Without Roots, live their lives independent from men and with a commitment to bring about the transformation of society through peaceful means. And Marie-Rose stands in front of the fascist young men of her country, confronting them with their perverted values, in an act that defies their violence and rejects them all together. This chabab gang is afraid of Marie- Rose who epitomizes feminine/feminist values and who dares confront them with words, showing them their corruption while asserting her w-humanism and her commitment to the oppressed and the downtrodden. They will have to get rid of her, just like the sniper had to get rid of Zahra.

Thus, while women writers are finding a way out, a circle of hell is being perpetuated, each sex fearing the other, the male one starting the chain through violence and domination. Only a different vision, new actions, and altered relationships based on trust, recognition, and acceptance of the other can help heal the wounds and bring about the cure necessary to project a new future for the world. Such a change has already started taking place with personal and political actions aimed at solving the problems rooted in oppression, domination, and the victimization of women. Writing this article has been one of these actions.

The connection between sexuality and war is so present in the novels that it is probably one of the most evident unifying themes. It demonstrates how strongly at work it is in the collective imaginary or culture of the people and how central it is to an understanding of the situation and the causes of the war. The similarities and differences between the ways women and men express and deal with violence and sexuality can lead us to a greater comprehension of the complexities in the relationship between the two and bring us closer to a solution: i.e., what I have described throughout this study as the need for a new rapport between men/women, women/ women, and men/men, relationships based on trust, recognition of the other, tenderness, equal sharing and love void of jealousy and possession. My contention being that the personal is political--a vision also dear to Feminist movements--changes in relationships traditionally based on domination, oppression and power games will inevitably bounce back on other spheres of life.

What Miriam Cooke writes about the Lebanese women writers’ vision of Lebanon as a sick child in need of care, became for me a reality. It was the Lebanese war, which made me want to go back and try to help. I would not have felt the same concern for Lebanon had it not been for the war and for what I perceived as real suffering in my friends and many of the people I came in contact with. I shared their pain and desire to remedy. It led me to apply for grants to go and teach there. My experiences in living the war, talking with students, teaching, conducting research, travelling in Lebanon, crossing the demarcation line dividing the city, participating in nonviolent peace initiatives, spending time in the shelter when shelling became too violent, sharing the anguish and suffering of friends and relatives, gave me insights I might not have had otherwise. It led to a conviction that only peaceful means could bring about a solution to Lebanon and reunite the country. It also showed me the importance of activism for the transformation of society: peace marches, hunger strikes, consciousness raising groups, solidarity among women, singing, writing, crossing the divided city, and most of all, changing the system of rapport between men and women, the values connected with these relations and the confessional structures tied to the concepts of honour, virginity, exclusive property and oppression.

It also became very clear to me that women’s solidarity and an international feminism, uniting women all over the world, are vital in bringing about such changes. I would like to stress the importance of achieving unity in the midst of cultural differences, if we want to provide some hope in ending the war culture which exists all over the world. I became very aware, when in Lebanon, of the strength the peace initiative started by two women from enemy communities had, first on women, and then on the population as a whole, in uniting people towards peace. It is one of the rare times in my life I witnessed the tremendous impact, which values of love and tolerance can have on people.

The activities I have described above--such as going to Lebanon, teaching, researching, living the war, crossing the demarcation line, participating in non-violent peace initiatives, discussing with students and with people directly affected by the war, writing a novel about it, composing songs on the war and performing them in public--undertaken as a result of my concern and suffering over the destruction of my country, are directly involved with the transformation of society. Changing the system and the values behind it requires more time and a long process of in-depth political, economical, psychological, religious, sexual, familial and social transformations established on an understanding of the different factors, causes and links between these various fields. My concern over long range plans to bring about social transformations necessary to end the war system and bring about hopeful and lasting changes to a world falling apart made me undertake this study and analyze the relationship between sexuality, war and literature.

When the English version of my novel The Excised was going into its second edition in 1994, I found myself being faced with mastectomy or lumpectomy, having being diagnosed with breast cancer. These two ectomies are lived by an increasing number of women all over the world, and particularly in the United States. It is the price we pay for modern civilization. The pollution, pesticides, depletion of the ozone layer, nuclear disasters, oestrogen induced carcinogens, mistreatment of nature are finally catching up with us. As Chikwenye Okonjo Ogunyemi well expresses in an article untitled, “Ectomies: A treasury of Juju Fiction by Africa’s Daughters,”: “Cultural determinism becomes the focal point of the politics of ectomy: to cut or not to cut? The mind boggles at Western culture’s playing on women’s bodies: hysterectomies, oopherectomies or ovariectomies, salpingestomies, episiotomies, mastectomies... I envision ectomy as a trope to express the excision, the cutting off, the exclusion attached to woman’s destiny25.” I was too overwhelmed by emotions, fears, anguish, rage, but also a renewed sense of the urgency, beauty and cruelty of life to be able to express what I was going through at the time, except in my journal. My journal became a publication: The Wounded Breast: Intimate Journeys through Cancer. Melbourne: Spinifex Press, July 2001, 543 pages (available as e-book on Voyages en Cancer (Préface Yves Velan). Paris: L’Harmattan, Tunis: Aloès, Beirut: An-Nahar, 2000, 448 pages. Phénix Prize 2001. The link that ties me to all the women around the world was being reinforced in this tribulation and sorrow.

In conclusion I would like to point out that those who suffer the most in wars and violent conflicts are women. They not only bleed from the devastations caused by wars and armed conflicts, often through rapes, torture and death, but they are also often crushed and rendered silent through practices such as crimes of honour, beatings, veils and confinement. It has become urgent to link all these various traumas of our time in order to gain better insights in how to solve them.


25 Chikwenye Okonjo Ogunyemi, “Ectomies: A treasury of Juju Fiction by Africa’s Daughters,”pp.4-5 (Forthcoming article).

Read More About Lupine Publishers Journal of Clinical & Community Medicine Please Click on Below Link: