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Medical Schools in Region Fight Caribbean Flow

For a generation, medical schools in the Caribbean have attracted thousands of American students to their tiny island havens by promising that during their third and fourth years, the students would get crucial training in United States hospitals, especially in New York State.

But in a fierce turf battle rooted in the growing pressures on the medical profession and academia, New York State’s 16 medical schools are attacking their foreign competitors. They have begun an aggressive campaign to persuade the State Board of Regents to make it harder, if not impossible, for foreign schools to use New York hospitals as extensions of their own campuses.

The changes, if approved, could put at least some of the Caribbean schools in jeopardy, their deans said, because their small islands lack the hospitals to provide the hands-on training that a doctor needs to be licensed in the United States.

The dispute also has far-reaching implications for medical education and the licensing of physicians across the country. More than 42,000 students apply to medical schools in the United States every year, and only about 18,600 matriculate, leaving some of those who are rejected to look to foreign schools. Graduates of foreign medical schools in the Caribbean and elsewhere constitute more than a quarter of the residents in United States hospitals.

With experts predicting a shortage of 90,000 doctors in the United States by 2020, the defenders of these schools say that they fill a need because their graduates are more likely than their American-trained peers to go into primary and family care, rather than into higher-paying specialties like surgery.

New York has been particularly affected by the influx because it trains more medical students and residents — fledgling doctors who have just graduated from medical school — than any other state. The New York medical school deans say that they want to expand their own enrollment to fill the looming shortage, but that their ability to do so is impeded by competition with the Caribbean schools for clinical training slots in New York hospitals.

Their argument is one that has been lobbed at Caribbean schools for decades: that those schools turn out poorly trained students who undercut the quality of training for their New York peers learning alongside them at the same hospitals.

And they complain that the biggest Caribbean schools, which are profit-making institutions, are essentially bribing New York hospitals by paying them millions of dollars to take their students. The American medical schools traditionally pay nothing, because hospitals like the prestige of being associated with universities.

“These are designed to be for-profit education mills to train students to pass the boards, which is all they need to get a license,” said Dr. Michael J. Reichgott, a professor at the Albert Einstein College of Medicine in the Bronx.

Charles Modica, chancellor of St. George’s University in Grenada, whose first class started studying in 1977, making it one of the oldest in the Caribbean, said the New York deans were simply afraid of competition.

“It’s basically a situation where the New York State deans just can’t hold their noses high enough up in the air, and I think it’s disgraceful,” said Mr. Modica, who founded St. George’s after he was rejected from medical school and went on to law school. Most Americans had never heard of the school until 1983, when President Reagan sent troops into Grenada, partly, he said, to rescue St. George’s American students from unrest.

The debate is so fraught that officials of Ross University, on the island of Dominica, were at first reluctant to talk about it, fearing students would be scared away from offshore schools.

“If the domestic schools felt we were taking opportunities away from their students, if they can specifically tell us what location we were taking them away from — that question was never answered,” said Dr. Nancy Perri, Ross’s chief academic officer.

The New York schools want the state to adopt the position of the American Medical Association, that “the core clinical curriculum of a foreign medical school should be provided by that school and that U.S. hospitals should not provide substitute core clinical experience.”

Under their proposal, the foreign schools could send students to New York only for electives, in their fourth year, not for core training, in their third. Short of that, the domestic schools want to stop any more foreign schools from sending students to New York for long-term clinical training while the state studies how it approves the schools.

The foreign schools do not go through the same accreditation process as the United States schools. So the state has its own process for approving foreign schools, but the New York schools contend it is not as thorough as the national accreditation process, and it should be.

The Regents are struggling to compare the academic and professional performance of students from the domestic and foreign schools. The Government Accountability Office, a federal agency, tried to do so in a report aimed at determining whether the foreign schools should continue to qualify for federal loans.

The report, issued in June, found that on average, foreign-trained students lagged behind their American-trained peers in passing the medical licensing exams. But over the last decade, they had narrowed the gap, especially in the clinical knowledge portion of the exams, which 75 percent of foreign-educated Americans passed on the first try in 2008, up from 57 percent in 1998. For students in American and Canadian schools, which are subject to the same accreditation process, the rate was 94 percent in 2008, about the same as 10 years earlier.

The report found few differences in the rates of disciplinary actions or malpractice payments between physicians educated abroad and in the United States.

A memorandum submitted to the Regents this month by Frank Muñoz, a deputy state education commissioner, suggested that the top Caribbean schools, like St. George’s, American University of the Caribbean and Ross, have been successful at establishing their academic merit.

“There is evidence,” Mr. Muñoz said, that the more mature Caribbean schools “admit students with very competitive backgrounds. It appears that many of these students were not granted admission to domestic schools because of the limited number of available seats.”

The New York schools say they now send about 4,400 of their students to New York hospitals for clinical training in their third and fourth years, and would need to expand that by 15 to 30 percent to help solve the doctor shortage.

Foreign schools send about 2,200 students, more than 90 percent of them from the Caribbean, according to the state. St. George’s alone sends about 1,000 students, many through a 10-year, $100 million contract with the New York City Health and Hospitals Corporation, which runs public hospitals. (A high-ranking St. George’s official, who also sat on the board of the city hospitals corporation, was fined for a conflict of interest for his role in soliciting clinical training slots for the school.)

City hospital officials have defended the contract with St. George’s as a way of getting students into hospitals in poor neighborhoods that have been shunned by New York schools. Once they have done their clinical training in those hospitals, the students often return as residents and then as full-fledged attending physicians, officials said.

But New York deans say the hospitals are taking too many students. “There are realistic limits to the number of students that can be placed in any one clinical environment and have a high-quality education take place,” said Dr. Lawrence G. Smith, dean of the Hofstra North Shore-LIJ School of Medicine, which will accept its first class of 40 students next fall.

The issue, which was reported this month in the Chronicle of Higher Education, is so charged that the city’s hospital trade group, the Greater New York Hospital Association, has declined to take a position. State officials say it is unclear just how many clinical trainees New York hospitals could reasonably accommodate, and they are surveying the hospitals to try to determine that.

Meanwhile, St. George’s continues to turn out doctors like Janine Reinhardt, 27, who grew up in Massapequa, N.Y., had a 3.97 grade-point average as a biology major at Cornell, but scored 27 on the MCAT. She said she probably needed a score of 30 to get into an American school.

Dr. Reinhardt graduated from St. George’s this year, and is now a resident in emergency medicine at Stony Brook University Medical Center, which was her first choice. She said her underdog status as a St. George’s student had made her work harder.

“At St. George’s, we’re rejected from the U.S. schools and then we feel we have something to prove, as opposed to the sense of entitlement that some U.S. medical students might feel,” Dr. Reinhardt said.

Visitors See North Korea Still Stunted by Its Isolation
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Girls’ soccer teams waged a fierce battle outside a huge gymnasium. Two young brides, one resplendent in a white gown and the other in deep pink, married sweethearts in a snowy square. Parents pulled toddlers on plastic sleds. Pedestrians lined up at kiosks to buy baked sweet potatoes and pancakes.

A six-day visit to Pyongyang, North Korea’s capital, that ended last Tuesday offered carefully monitored glimpses of a land where reality and fantasy are routinely conflated. While there were no obvious signs of impending collapse or political intrigue swirling around the fate of North Korea’s ailing leader, the visit offered hints of why the North might be particularly eager now to resume international aid and trade.

For nearly four years, an unrelenting barrage of government propaganda has promised that North Korea will be strong and prosperous by 2012, the centennial of the birth of Kim Il-sung, the nation’s founder and the father of the current leader, Kim Jong-il.

That is now 18 months away. And prosperous is the last word one would use to describe North Korea’s shuttered factories, skimpy harvests and stunted children.

Perhaps with that deadline in mind, North Korea’s leaders last week made what might be a bid to reduce their isolation. They offered concessions that could help open up and limit the country’s increasingly sophisticated nuclear program.

And after promising to retaliate militarily should South Korea renew artillery drills near disputed waters, they have reacted — so far — only with words. But North Korea has made conciliatory gestures before, to extract aid at times of economic need or political transition, only to turn hostile later.

Of the nation’s 24 million citizens, the three million in Pyongyang are the most privileged. North Koreans need a special permit to live or come here. Still, signs of hardship are evident.

Commuters crammed into decrepit electric buses, packed as tightly as boxes of toothpicks. Pedestrians bowed beneath huge bundles strapped to their backs, apparently stuffed with goods for trade in private markets that have eclipsed the ill-supplied state stores. Most were women; one collapsed on the sidewalk under the weight of her load.

Economists say coal production is, at best, half that of two decades ago, and Pyongyang has regular power shortages. At the elite Foreign Language Revolution School, students warmed themselves around stoves fed by coal or wood. In much of the city, residents report only a few hours of electricity daily.

New apartment buildings — apparently for officials — grace the city center. But the pyramid-shaped, 105-story Ryugyong Hotel remains a shell nearly 25 years after construction began. While it was recently sheathed in glass, other abandoned construction projects scar roads outside the city.

Elsewhere, especially in northern provinces, residents report that child beggars haunt street markets, families scavenge hillsides for sprouts and mushrooms and workers at state enterprises receive nominal salaries, at best. Workers in Pyongyang are said to be much better compensated.

Signs of that relative good fortune were evident on Pyongyang’s streets. Some pedestrians chatted on cellphones, something unknown just two years ago. Koryolink, a cellphone network controlled by an Egyptian firm, has 310,000 North Korean subscribers. North Koreans can call only one another, but the network is expanding fast. Residents report more cars and traffic lights than three years ago, although traffic remains sparse.

Most pedestrians appeared well fed. Although malnutrition has improved in the past decade, one in three North Korean children is stunted, and nearly one in five is underweight, according to the World Food Program. Residents of the Pyongyang area are the nation’s best nourished.

North Korea’s isolation is striking from the moment of arrival at Pyongyang’s utilitarian airport. With a 40-plane, primarily Russian-made fleet, Air Koryo schedules just two daily outbound flights, to Beijing and to Vladivostok in far eastern Russia. Although visitors were allowed to bring laptops, inspectors immediately confiscated cellphones.

Journalists are rarely granted visas to North Korea, one of the world’s most secretive and militaristic societies. The government allowed two journalists to accompany Gov. Bill Richardson of New Mexico, a former ambassador to the United Nations, on a private mission to meet senior officials in Pyongyang.

Mr. Richardson sought to reduce the threat of conflict between North and South Korea and to persuade the North to abandon its aggressive behavior if it wants outside assistance.

Visiting Pyongyang as an outsider is a bit like entering a parallel reality. Official escorts stuck to visitors like Velcro. The rules were clear: No interviews without permission. No exploring beyond the hotel parking lot.

Everyone was closely watched, with tactics reminiscent of a bad cold war spy movie. Opposite a journalist’s spacious room at the mostly empty Potonggang Hotel, men with briefcases left keys dangling in doors and appeared to rotate shifts. Other guests warned that dining room tables were bugged and that a dark, out-of-place wall panel was in fact a two-way mirror. Calls from the United States were blocked. Outgoing overseas calls cost $8.27 a minute.

Some events seemed obviously staged. On a dazzlingly sunny Saturday, a crowd packed the auditorium of Pyongyang’s ornate central library for a lecture on the life of Kim Jong-il’s mother. Nearly every seat in the reading room was also taken. When one reader nodded off, a watchful monitor quickly poked him.

But the Foreign Ministry also showed surprising flexibility at times, allowing visits to the foreign language school, a crowded subway station and a silk-thread factory. Long-time visitors say they see a growing openness to journalists.

State stores were off limits, either because barren shelves hinted at economic difficulties or because only lucky government-coupon holders could take advantage of their artificially low prices. Window-shopping only, journalists were warned.

Better-stocked but costlier private markets were also out of bounds. Hundreds have sprung up nationwide, but officials play down their importance because they flout the socialist credo.

One, the huge, arch-roofed Unification Market in Pyongyang, sports row after row of stalls. Merchants say three-fourths of the wares come from China.

With paltry harvests, inflation of food prices is a chronic problem. Last month, the World Food Program reported that at that market a kilogram of rice, or 2.2 pounds, cost $10, about 10 times the price in Beijing. By the agency’s rough estimates, a typical household’s income would allow one person to eat two and a half cups of rice a day, assuming he had no other expenses.

North Koreans pride themselves on juche, or self-reliance, and government officials greeted Mr. Richardson with declarations of a thriving society.

“Everything is going well,” Vice President Kim Yong-dae assured the governor before reporters were shooed out of a meeting. “Thanks to our powerful military deterrence,” he said, “we can now concentrate on development” and achieve prosperity by 2012.

But privately, Mr. Richardson said, officials acknowledge that the country is desperate for fuel, food and an easing of economic sanctions imposed after North Korea’s missile and nuclear tests, beginning roughly five years ago. Some North Korea analysts warn that unless aid and trade resume, the North may raise cash by selling nuclear technology and materials to Iran, Syria or others — if it has not already.

Interviews in the past six months with nearly 20 North Koreans who recently left for China, including several Communist Party members, suggest that faith in the leadership’s economic policies is shaken, if not lost. North Koreans know well that South Koreans live much better, while their own government demands constant sacrifice.

A few criticize the military’s pre-eminence, and hope that Kim Jong-un, Kim Jong-il’s son and chosen successor, will shift policy. “I heard a rumor that he said we have more bullets than food. So maybe he will be a good leader and feed the people,” one 59-year-old North Korean trader said, hopefully, in an interview last month in China.

But most seemed to support Kim Jong-il’s 15-year-old “military-first” policies. They regard the United States as an implacable enemy and South Korea as an American tool, barred by Washington from uniting with the North. They insist that Japan’s 35-year occupation of the peninsula, followed by the Korean War, proves the need for an invincible defense.

Billboards, patriotic songs, newspapers and movies continually reinforce that message. Every North Korean man spends up to 10 years in the military. Soldiers were spotted helping out at a Pyongyang construction site and heading through a nearby village toting shovels as a loudspeaker mounted on a tree blared patriotic messages.

“Even if we don’t eat, we give the military everything we can,” said a former humanities professor from the northern city of Chongjin, who now works as a maid in China but plans to return home. “Nuclear weapons mean we cannot be invaded. I really want to say that. We cannot be touched.”

At one Pyongyang subway stop, called Prosperity Station, commuters read news on the threat of military conflict with South Korea from newspaper pages posted on a stand-up carousel. “We want peace,” one man declared passionately. “But we are not afraid of war. We are ready for anything.”

Such statements aside, he and other residents were surprisingly friendly to journalists. So were government escorts. The six-day visit ended with a cognac-fueled celebration in the hotel’s karaoke bar in which the North Koreans belted out “You Are My Destiny” and Korean love songs.

The days were marked by odes to Kim Jong-il. Choi Hyok, 43, the rail-thin chief engineer at the Kim Jong-suk Silk Factory, which is named after the chairman’s mother, recalled Kim Jong-il’s visit in January 2009. “I felt like I had come out of the darkness and into the light,” he said.

Nam Dae-yong, 20, a geology student at Kim Il-sung University, marveled at 2,000 new desktop computers installed in April. “This is a very good present from Chairman Kim Jong-il,” she said.

The university is a showpiece. So is the silk factory, with its well-oiled machinery and 2,000 women at work in blue, pink and green scarves. Economists estimate that three of four North Korean factories are idle, lacking power and materials.

“Everyone knows the environment,” the former humanities professor said of her university in Chongjin. “No electricity, no light, no heat. The government doesn’t give anything, so we have to ask the parents for money.”

“People talk a lot about 2012, how we will become a strong and prosperous country,” one 45-year-old trader from Hwanghae Province told the advocacy group Human Rights Watch last month. “If we find a gold mine, yes, I guess it would happen.”

“Nobody really believes it,” he said. “We just get by.”

African Huts Far From the Grid Glow With Renewable Power

For Sara Ruto, the desperate yearning for electricity began last year with the purchase of her first cellphone, a lifeline for receiving small money transfers, contacting relatives in the city or checking chicken prices at the nearest market.

Charging the phone was no simple matter in this farming village far from Kenya’s electric grid.

Every week, Ms. Ruto walked two miles to hire a motorcycle taxi for the three-hour ride to Mogotio, the nearest town with electricity. There, she dropped off her cellphone at a store that recharges phones for 30 cents. Yet the service was in such demand that she had to leave it behind for three full days before returning.

That wearying routine ended in February when the family sold some animals to buy a small Chinese-made solar power system for about $80. Now balanced precariously atop their tin roof, a lone solar panel provides enough electricity to charge the phone and run four bright overhead lights with switches.

“My main motivation was the phone, but this has changed so many other things,” Ms. Ruto said on a recent evening as she relaxed on a bench in the mud-walled shack she shares with her husband and six children.

As small-scale renewable energy becomes cheaper, more reliable and more efficient, it is providing the first drops of modern power to people who live far from slow-growing electricity grids and fuel pipelines in developing countries. Although dwarfed by the big renewable energy projects that many industrialized countries are embracing to rein in greenhouse gas emissions, these tiny systems are playing an epic, transformative role.

Since Ms. Ruto hooked up the system, her teenagers’ grades have improved because they have light for studying. The toddlers no longer risk burns from the smoky kerosene lamp. And each month, she saves $15 in kerosene and battery costs — and the $20 she used to spend on travel.

In fact, neighbors now pay her 20 cents to charge their phones, although that business may soon evaporate: 63 families in Kiptusuri have recently installed their own solar power systems.

“You leapfrog over the need for fixed lines,” said Adam Kendall, head of the sub-Saharan Africa power practice for McKinsey & Company, the global consulting firm. “Renewable energy becomes more and more important in less and less developed markets.”

The United Nations estimates that 1.5 billion people across the globe still live without electricity, including 85 percent of Kenyans, and that three billion still cook and heat with primitive fuels like wood or charcoal.

There is no reliable data on the spread of off-grid renewable energy on a small scale, in part because the projects are often installed by individuals or tiny nongovernmental organizations.

But Dana Younger, senior renewable energy adviser at the International Finance Corporation, the World Bank Group’s private lending arm, said there was no question that the trend was accelerating. “It’s a phenomenon that’s sweeping the world; a huge number of these systems are being installed,” Mr. Younger said.

With the advent of cheap solar panels and high-efficiency LED lights, which can light a room with just 4 watts of power instead of 60, these small solar systems now deliver useful electricity at a price that even the poor can afford, he noted. “You’re seeing herders in Inner Mongolia with solar cells on top of their yurts,” Mr. Younger said.

In Africa, nascent markets for the systems have sprung up in Ethiopia, Uganda, Malawi and Ghana as well as in Kenya, said Francis Hillman, an energy entrepreneur who recently shifted his Eritrea-based business, Phaesun Asmara, from large solar projects financed by nongovernmental organizations to a greater emphasis on tiny rooftop systems.

In addition to these small solar projects, renewable energy technologies designed for the poor include simple subterranean biogas chambers that make fuel and electricity from the manure of a few cows, and “mini” hydroelectric dams that can harness the power of a local river for an entire village.

Yet while these off-grid systems have proved their worth, the lack of an effective distribution network or a reliable way of financing the start-up costs has prevented them from becoming more widespread.

“The big problem for us now is there is no business model yet,” said John Maina, executive coordinator of Sustainable Community Development Services, or Scode, a nongovernmental organization based in Nakuru, Kenya, that is devoted to bringing power to rural areas.

Just a few years ago, Mr. Maina said, “solar lights” were merely basic lanterns, dim and unreliable.

“Finally, these products exist, people are asking for them and are willing to pay,” he said. “But we can’t get supply.” He said small African organizations like his do not have the purchasing power or connections to place bulk orders themselves from distant manufacturers, forcing them to scramble for items each time a shipment happens to come into the country.

Part of the problem is that the new systems buck the traditional mold, in which power is generated by a very small number of huge government-owned companies that gradually extend the grid into rural areas. Investors are reluctant to pour money into products that serve a dispersed market of poor rural consumers because they see the risk as too high.

“There are many small islands of success, but they need to go to scale,” said Minoru Takada, chief of the United Nations Development Program’s sustainable energy program. “Off-grid is the answer for the poor. But people who control funding need to see this as a viable option.”

Even United Nations programs and United States government funds that promote climate-friendly energy in developing countries hew to large projects like giant wind farms or industrial-scale solar plants that feed into the grid. A $300 million solar project is much easier to finance and monitor than 10 million home-scale solar systems in mud huts spread across a continent.

As a result, money does not flow to the poorest areas. Of the $162 billion invested in renewable energy last year, according to the United Nations, experts estimate that $44 billion was spent in China, India and Brazil collectively, and $7.5 billion in the many poorer countries.

Only 6 to 7 percent of solar panels are manufactured to produce electricity that does not feed into the grid; that includes systems like Ms. Ruto’s and solar panels that light American parking lots and football stadiums.

Still, some new models are emerging. Husk Power Systems, a young company supported by a mix of private investment and nonprofit funds, has built 60 village power plants in rural India that make electricity from rice husks for 250 hamlets since 2007.

In Nepal and Indonesia, the United Nations Development Program has helped finance the construction of very small hydroelectric plants that have brought electricity to remote mountain communities. Morocco provides subsidized solar home systems at a cost of $100 each to remote rural areas where expanding the national grid is not cost-effective.

What has most surprised some experts in the field is the recent emergence of a true market in Africa for home-scale renewable energy and for appliances that consume less energy. As the cost of reliable equipment decreases, families have proved ever more willing to buy it by selling a goat or borrowing money from a relative overseas, for example.

The explosion of cellphone use in rural Africa has been an enormous motivating factor. Because rural regions of many African countries lack banks, the cellphone has been embraced as a tool for commercial transactions as well as personal communications, adding an incentive to electrify for the sake of recharging.

M-Pesa, Kenya’s largest mobile phone money transfer service, handles an annual cash flow equivalent to more than 10 percent of the country’s gross domestic product, most in tiny transactions that rarely exceed $20.

The cheap renewable energy systems also allow the rural poor to save money on candles, charcoal, batteries, wood and kerosene. “So there is an ability to pay and a willingness to pay,” said Mr. Younger of the International Finance Corporation.

In another Kenyan village, Lochorai, Alice Wangui, 45, and Agnes Mwaforo, 35, formerly subsistence farmers, now operate a booming business selling and installing energy-efficient wood-burning cooking stoves made of clay and metal for a cost of $5. Wearing matching bright orange tops and skirts, they walk down rutted dirt paths with cellphones ever at their ears, edging past goats and dogs to visit customers and to calm those on the waiting list.

Hunched over her new stove as she stirred a stew of potatoes and beans, Naomi Muriuki, 58, volunteered that the appliance had more than halved her use of firewood. Wood has become harder to find and expensive to buy as the government tries to limit deforestation, she added.

In Tumsifu, a slightly more prosperous village of dairy farmers, Virginia Wairimu, 35, is benefiting from an underground tank in which the manure from her three cows is converted to biogas, which is then pumped through a rubber tube to a gas burner.

“I can just get up and make breakfast," Ms. Wairimu said. The system was financed with a $400 loan from a demonstration project that has since expired.

In Kiptusuri, the Firefly LED system purchased by Ms. Ruto is this year’s must-have item. The smallest one, which costs $12, consists of a solar panel that can be placed in a window or on a roof and is connected to a desk lamp and a phone charger. Slightly larger units can run radios and black-and-white television sets.

Of course, such systems cannot compare with a grid connection in the industrialized world. A week of rain can mean no lights. And items like refrigerators need more, and more consistent, power than a panel provides.

Still, in Kenya, even grid-based electricity is intermittent and expensive: families must pay more than $350 just to have their homes hooked up.

“With this system, you get a real light for what you spend on kerosene in a few months,” said Mr. Maina, of Sustainable Community Development Services. “When you can light your home and charge your phone, that is very valuable.”

Riker's Reading Program Lets Fathers Parent

THERE once was a man who read an unabridged dictionary from cover to cover to keep from losing his mind. Solitary confinement can do that to you, make you read what you would never look at on the outside, and then read more and more of it, to preserve your sense of humanity, maybe, but certainly to maintain whatever flimsy connection you hold to the world beyond your prison cell.

The other choice was to go crazy, or at least that was how it felt to José Rosado, or José Rosaldo, or José Reyes; his identity varies based on his crime and conviction. Mr. Rosado, 42, is a scraggy recovering addict with a 10th-grade education halfway through an eight-month stint on Rikers Island.

Mr. Rosado, known around the jailhouse as “professor,” has a wife, three sons and 52 books waiting for him in a public-housing project in East New York, Brooklyn. The books have been his anchor, he said, grounding him not to reality, but to distant times, faraway places and magical corners of his imagination, where heroin does not command him to do the bad things he has done.

For nearly a decade, Mr. Rosado has often spent 23 hours a day alone in a cell in the criminal justice system’s equivalent of “time out.” That was where he read — about Freemasonry and kabbalah, about ancient history, anthropology and archaeology. He has read the Bible and the Koran — “the whole 114 suras,” or chapters, he said, “from Al-Fatiha to Al-Nas,” the first and the last.

“Knowledge will get you to a lot of places,” Mr. Rosado said.

It did not keep Mr. Rosado out of Bare Hill, Clinton, Southport and Attica — prisons across New York State, far from his home in Brooklyn. He has been in and out since 1989, for burglary and drugs and, most recently, third-degree assault, often extending his stints with bad behavior: his prison disciplinary record runs for six pages.

These days, Mr. Rosado is reading “Fox in Socks” and “Hop on Pop” and “Clifford y la Hora del Baño.” Juan Camacho, 35, a drug dealer and father of two, is partial to “The Cat in the Hat” (though he says he did not like the movie as much because “it doesn’t have the same rhyming, the classic of it”). And Qaaid Reddick, 27, who has never met his third daughter because she was born while he was behind bars on a weapons charge, is paging through “Merry Christmas, Curious George.”

They are three of the eight men at the Eric M. Taylor Center — one of nine jails on Rikers Island — who completed a five-week literacy course this fall called “Daddy and Me,” in which they recorded themselves reading children’s books for the sons and daughters they had left behind. It was the first time such a program had been tried at Rikers, though there have been many similar efforts, most focusing on female inmates in prisons across the country, since at least 1996.

“People are multidimensional,” said Dora B. Schriro, the city’s Correction Department commissioner. “Part of being a man is being a dad, and part of being a good man is being a good dad, in the most fundamental sense of the word.”

Financed with about $3,800 from a family literacy grant from the state, the program at the Taylor Center was run by Nick Higgins, supervising librarian at the New York Public Library’s correctional services program. On the first day, Mr. Higgins told the inmates, “Our objective is to hopefully change the attitude that some of you might have about reading to children, that reading is Mom’s job.”

Over five weeks, Mr. Rosado learned to calibrate his raspy voice to a higher pitch. Mr. Camacho learned to contort his facial muscles into humorous expressions. Mr. Reddick, on the back end of his sixth stay at Rikers since 2005, rediscovered “The Little Engine That Could,” a book he remembered reading in elementary school.

THE inmates — in olive-green jumpsuits that seemed too big for their frames, with the names of their mothers, girlfriends and children tattooed on their skin — had a long table of children’s books from which to choose: “Goodnight Moon,” “The Itsy Bitsy Spider,” “El Zorrito.”

“I like monkeys,” Mr. Reddick said as he got acquainted with Curious George. “They’re the closest thing to a human being.”

As a child, Mr. Reddick lived on East 92nd Street in Manhattan, near a Presbyterian church that had a strawberry shortcake festival he never missed. He said he was arrested for the first time at age 14 for punching a boy who had disrespected him. Since then, he has been in and out of prison, mostly for assault; on May 29, he was arrested on Staten Island with a gun in his backpack. When asked where he grew up, Mr. Reddick said, “Right here,” meaning Rikers. He has three daughters: Mary Jane is 4, Ma’Naiya is 3, and Mya was born on Oct. 18. He was looking forward to the celebration at the end of the reading program, when children would visit their fathers and get the CDs the men had recorded on a Marantz PMD660, because it would be the first time he would see the baby.

At the first session, Mr. Reddick tried reading in front of the group, but was barely audible. “See the man in the yellow hat at the — ” He stopped midsentence and stuck out his tongue. “I misspoke,” he said sheepishly. At the third session, he read the book until the end, but with no inflection in his voice, as if he had been forced into it. By the next week, when it was time to record, he had abandoned the little monkey for the little engine he recalled from his childhood: I think I can, I think I can.

That was for Mary Jane. For Ma’Naiya, he chose “Papa, Do You Love Me?”, a modern story inspired by the Masai tribe in Kenya. Mr. Reddick had never heard of the book, but he liked the title. He did not select a story for Mya.

“Mya is too little for books,” Mr. Reddick said.

On the program’s fifth and final session, last month, Mr. Reddick and the others were escorted to the jail’s visiting room. Each of them commanded a set of colorful chairs arranged in a circle to welcome their families. Mr. Reddick sat among the red and green chairs, waiting. He watched as the other inmates hugged their babies and their babies’ mothers. He listened to them read their stories.

A girl laughed heartily as her father tickled her belly. A woman asked one of the correction officers if her daughter could have another cup of juice. The officer told her she did not have to ask; the juice and doughnuts had been laid out for the families.

Mr. Reddick sat alone for some time, staring at the CDs and books on the table before him, then staring into nothing. Eventually, he joined two other inmates whose families had not come either. They chatted, their backs turned to the men whose families were there.

He knew Mary Jane and Ma’Naiya would not be coming; they live on Staten Island with his sister, who, he said, thinks they should not see their father in jail. But he had expected Baby Mya. Later, he learned that her mother had woken up too late to catch the bus.

“No promises made, no promises broken,” Mr. Reddick shrugged.

MR. CAMACHO said he had a lot of children’s books in the apartment in the Hunts Point section of the Bronx, where his wife, Jasmine Bosch, lives with their two boys, José, 8, and Steven, 4; two dogs; and a cat named Tiger. But none were visible on a visit to the first-floor one-bedroom apartment one rainy afternoon. Ms. Bosch, who is 27 and unemployed, said that there were some, in a bin somewhere in the boys’ closet, but that she had no time to read them.

Ms. Bosch said that she woke up at 6:30 a.m. and that by 7, she and the boys would already be fighting. She fights to rouse José, to get him ready and out the door to get to school on time. She fights to keep Steven under control as she rushes to get breakfast.

Sometimes, cockroaches emerge from under the kitchen cabinets and crawl onto the table. Ms. Bosch said that she had gotten used to the roaches, but that she did not like the mice. That’s why she got Tiger. Tiger likes to eat cockroaches, too.

The apartment smells like stale cigarettes. Ms. Bosch smokes Newports, which she buys by the carton in New Jersey. She said she tried not to smoke in front of the boys, and also not to cry.

“I do my best,” she said.

While José and Steven are in school, Ms. Bosch said, she washes and folds, cooks and cleans, feeds Tiger and walks the dogs, one of whom is an old mutt who is half-blind and tends to crash into everything.

Ms. Bosch is dyslexic. She cannot read to the boys unless it is an easy book. José is dyslexic, too, “or something like that,” she said. “He needs help when he brings homework home.”

It was Mr. Camacho who taught the boys to write their names. Steven traced his four times that rainy afternoon. “Homework,” he said, waving the sheet of paper over his head.

During the Daddy and Me sessions, Mr. Camacho stumbled over the silly singsong of “The Cat in the Hat,” at one point saying, “I can already imagine José giggling.” Then, he said he hoped the boys would not be afraid of making mistakes, but would learn from them and not repeat them.

At the final session, he told José, who is 4-foot-11 and weighs 120 pounds, to eat more fruit. Then, before his family walked away, he grabbed the boy by the arm and said, “When you hear my voice, remember that daddy is there with you.”

Mr. Camacho has been at Rikers since June. The police had found 56 bags of crack cocaine in the pocket of a jacket in a hallway closet in his home, along with a marijuana pipe and five .38 Special bullets. Ms. Bosch kept track of the days until his scheduled Dec. 15 release on a calendar taped to the wall.

“My baby is coming home soon,” she said in early November.

But it did not turn out that way.

Instead, on Nov. 17, Mr. Camacho was transferred to the Metropolitan Correctional Center in Lower Manhattan, to face federal drug conspiracy charges that carry a minimum sentence of 10 years.

A federal indictment said Mr. Camacho — or “Papito Camacho,” as he is known on the streets — had sold a dozen bags of crack to an undercover police officer near his home on Manida Street, part of an enterprise that involved 12 others.

IN the recording room, Mr. Rosado pronounced Seuss as “Zeus” and read the words of “Fox in Socks” as if he were singing a rap song. “This-is-what-they-CALL-a-TWEET-le-BEE-tle-NOO-dle-POO-dle-BOT-tled-PAD-dled-MUD-dled-DUD-dled-FUD-dled-WUD-dled-FOX-IN-SOCKS-sir!”

He turned the page.

“There goes that little girl you like,” he said into the microphone, his eyes on one of the book’s characters, Sue, with her wavy hair and lips locked in a perpetual frown.

He was speaking to a child who was not there: Karabalí, 7, his eldest, who was named for a character in a Puerto Rican legend Mr. Rosado once read in prison, a runaway slave who eluded his captors even after his death. His second son, Cofresí, 6, is named after a 19th-century Puerto Rican pirate who robbed ships carrying gold from the island. The third is José, who is 5 and named for his father, a Puerto Rican who has a long rap sheet filled with heroin and burglary convictions.

Mr. Rosado bought his first book out of a prison catalog, in 1994, after he was ordered to spend 365 days in isolation for slashing another inmate. It was Random House Webster’s Unabridged Dictionary, and it cost $99, he said.

Later, he read Sun Tzu’s “Art of War,” which dissected military operations written more than 2,000 years ago. He read Robert Temple’s “Sirius Mystery,” which explored extraterrestrial beginnings of the human civilization. He read National Geographic’s “Lost Kingdoms of the Maya” and Henry Brun’s “Global Studies: Civilizations of the Past and Present,” which is more commonly assigned to teenagers in high school.

“People treat you better when you have an education,” Mr. Rosado said. “I always tell my kids, ‘Read, read, read.’ ”

He met his wife, Olguita, after he came out of state prison in 2002 and moved to Orlando, Fla., where he found work building cabinets for a cousin’s small construction business. The housing market was booming, and for four years, he said, he made money and walked the line.

But when the housing market crumbled and work dried up, Mr. Rosado started getting high again. He tried to escape to Brooklyn, where he toiled as a tile maker for two years, but the company folded as the economy sputtered. On Aug. 17 , he was caught robbing a deli near his home. “We have cellphone, cable, house phone,” Mr. Rosado said, ticking off bills by way of explanation. “We have children, and we want them to eat nice, to dress up nice. I just got caught up. Did what I had to do.”

He got to Rikers a few days later and is scheduled for release on April 11.

“Block everything out, take a deep breath and pretend you’re reading to them,” Mr. Rosado mumbled to himself as he headed to the Daddy and Me recording room one Thursday morning.

Sometimes, he closed his eyes and broke from the text to address his sons. He apologized to Karabalí for stumbling on Dr. Seuss’s tongue-twisting rhymes. He reminded Cofresí about Timbuktu, “home of the ancient African civilizations,” after coming across the name in “Hop on Pop.”

“The book is bilingual,” he explained to little José about Clifford.

“You know English and Spanish, Papi, so when I talk to you in Spanish, you answer in Spanish, and when I talk to you in English, you answer in English.”

“Papi,” he added, “I love you. I’ll see you soon.”

Soon was a week later, in that visiting room with the brightly colored chairs. Cofresí told his father about the day someone fired a gun right outside their apartment door just a minute after he and his mother had stepped inside. Sitting on his mother’s lap, José read the English and Spanish words in the Clifford book.

On one side of the room was a bookcase full of children’s stories. Karabalí had raced to it almost as soon as he had arrived, grabbed one of the books and demanded, in a way that only a child can: “Daddy, read for me.”

And here's one on eating your Christmas tree! I gotta say, the people in the comments clearly didn't read the same books growing up that I did, because none of them seems to have ever heard that one can do this.

IN Denmark, as in the United States, the Christmas tree is a primary icon of the season, along with the falling snow and Father Christmas. On Juleaften, or Christmas Eve, around 9 or 10 p.m., most Danish families join hands, dance in a circle around the tree and sing carols — a communal yet intimate celebration of Christmas.

Then we exchange presents and everyone exclaims over his homemade cookies, marzipan and other sweets, along with dried fruits and nuts.

Despite all the sentiment we attach to our Christmas trees, we still get rid of them quickly once the holiday ends. Three or four days after Christmas, abandoned trees are discarded in the streets as if they were garbage.

Isn’t that a shame? Nature takes enormous time and effort to produce something that we use only briefly. Why don’t we make greater use of this living tree, as we make use of so many other kinds of plants on earth, by eating it? Is it because, having served as the focus of such an important family event, the tree comes to seem like part of the family? Maybe for us Westerners the Christmas tree becomes, if only briefly, like a beloved pet. And who would like to eat their dog or cat?

That is also a shame, because evergreens are delicious. At my restaurant we use their needles as a spice. You can cook with a branch of spruce or fir as you would a sprig of rosemary or thyme. Wouldn’t it be beautiful if families gathered after Christmas, festively removed the decorations and then cut off the tasty needles of the tree to flavor their food?

The needles can be dried and mixed into a powder that makes a light, citrus-y and very aromatic spice. Sprinkle that powder into cookie dough, add some to rice as you cook it, or even rub it on chicken before roasting. Dried needles can even be used to smoke meat, and then you can use the tree’s wood for kindling.

Small spruce branches can also be used to add flavor. The next time you steam spinach or other greens, throw one in at the very last minute to give a light aroma and a lemony feel to the dish. Or, after cooking steak in a pan, flavor the cooking butter with a fistful of spruce needles. I find that game meats respond especially well to these flavors — which is not surprising, when you consider how animals like to eat the tender, bright-green shoots in spring.

Spruce and fir are useful in many other dishes as well. Fresh fish, salted for a day and covered in fresh needles, absorbs the forest aroma and emerald color into its flesh. Needles work especially well in oils and vinegars, condiments that my staff and I lavish on fresh sweet peas every spring.

Each year more than 100 million trees are produced for Christmas worldwide. Considering that it takes 8 to 12 years to produce a decent-sized tree, it seems pointless simply to discard this bounty after only a few weeks of using it as ornamentation. I don’t mean to sermonize. I want only to point out that food is everywhere, that a tree is more than a symbol or a decoration: it is delicious food.

This year, let’s all butcher the tree. Below are three recipes that will let you make the most of it.

Spruce Butter

7 ounces butter

3 ½tablespoons pine needles

Sprig of lemon thyme.

1. Mix in a blender for eight minutes until soft and green.

2. Pass through a chinois sieve.

Spruce Oil

3 ½ ounces pine needles

3-4 tablespoons finely chopped parsley

1 ¼ cups neutral oil.

1. Blanch needles for four minutes, then dry.

2. Mix all ingredients in a blender until they reach 160 degrees.

3. Pass through a chinois sieve.

Spruce Vinegar

3 ½ ounces pine needles

3 ½ ounces apple vinegar.

1. Briefly mix in blender.

2. Place in a sealed container overnight.

3. Pass through a chinois sieve.

Date: 2010-12-29 08:41 pm (UTC)
From: [identity profile]
I use spruce new-growth tips in beer sometimes.

(I favor small, quick-growing Douglas Fir for my christmas trees, and absolutely refuse to support the commercial market. It ain't like we gots a shortage of the things, after all (

Date: 2010-12-29 10:30 pm (UTC)
From: [identity profile]
Using the Christmas tree needles is a great idea for people who cut their own real trees. With commercially-grown, boughten trees, one might wonder what might have been sprayed on them, either in their growing or after their cutting: since they're not marketed as food, their growers are not restricted to food-grade pesticides or preservatives.

When I was a child, after Christmas we hung the tree with peanut-butter-and-birdseed pinecones and put it out in the yard for awhile, until my Dad eventually sawed it up for firewood. As an adult, I bought live trees - pitiful little Charlie Brown trees, none of which survived their planting for more than a year - a couple of times, but mostly didn't bother, because we always went to my parents' for the holidays, and they always had the big tree with all the trimmings. After my Dad died, my Mom got a small, fairly real-looking fake tree with the lights already built in, which is now mine.

I never would have thought I'd be happy with a fake tree, but I wasn't too happy with cutting down a perfectly good tree just for decoration, nor with spending a lot of money for a live tree that didn't remain live, so this is better. LOL, this is what comes of too much Hans Christian Anderson in childhood; every tree was The Little Fir Tree to me, and that's never really worn off.


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