It
is said, “journeys help you discover your true inner self”. My third visit
abroad to Mexico to attend 12th annual conference of the
International Society of Pharmacovigilance at Cancun was not as smooth and
hassle-free as my earlier two trips to Turkey and Australia but it helped me
have a glimpse of the resolute self inside me. This time I was going to present
a couple of my accepted research papers at the conference that was scheduled to
be held between October 30th to November 2nd, 2012 at
Hotel J. W. Marriott, Cancun, Mexico – the land of Mayan civilization.
Air travel:
I
commenced my journey from Srinagar and my first stop-over was at Delhi followed
by Mumbai. Upon reaching Mumbai while I was marching ahead to go through
immigration clearance and catch my next flight to New York I got the shocker
that all flights to New York have been cancelled owing to the threat of hurricane
Sandy looming large over the East Coast of USA. The queue of affected
passengers was horribly long and after a wait of over three hours in the queue
I could make up to the airlines counter where I was offered a refund in case I
opted to abandon my trip. But in spite of the apprehensions of getting stranded
somewhere in Europe or America, I chose to go by some alternative route. I was
reminded of an anonymous quote, “If you don’t get
lost, there’s a chance you may never be found.” They
offered me a route in which I had to change four planes from Mumbai to London
to Houston to Mexico City to Cancun and my original journey of 21 hours was
getting overstretched to more than 48 hours. I accepted their offer and boarded
my flight with words of Alex Noble reverberating in
my mind, “Success is not a place at which one arrives but rather the spirit
with which one undertakes and continues the journey.”
 |
| Decorated Christmas tree at London Heathrow airport |
Upon arriving at London Heathrow airport, it was cold and raining. I
rang up to my home to inform them about the changed schedule. London
Heathrow was a very busy airport and after we landed I could see at least seven
planes lined up in the air waiting for their turn to land. Before our landing
we circled many times over London and in the process we could have a detailed
glimpse of the London city from air. My next stop was Houston, from where I
flew to Mexico city. After going through my immigration clearance at Mexico
City, I reported at the ticket counter 45 minutes before my next connecting
flight. Travel agent shocked me by saying that check in closes one hour before
the actual flight and therefore I won’t be able to check myself in. I had to
catch the air train and rush back to the International terminal to contact my airlines
agent for the next flight. To my surprise in the entire hall of more than 20
ticket counters, not even a single counter was operative. On top of it no Adam
or Eve around was able to speak or understand even a single word in English.
After great difficulty I could locate
a person for claiming my baggage and he generated a printed ticket for me from
his computer and told me to rush back to domestic terminal for catching the
next flight to Cancun scheduled at 10 pm. This time air train was very cruel on
me since it was arriving to pick me up only after a gap of 15 minutes which I
was not in a position to afford since it was already 9 pm and I had to check in
immediately. Somehow I reached the check in counter and they checked me in at
the eleventh hour and I boarded my sixth and last flight to Cancun. However all
miseries were not over for me yet. Upon reaching Cancun I received another blow
when I was told that my baggage has not arrived and will be delivered later at
my hotel. Consequently I had to spend the first day of the conference uneasily in
my travel attire. However my room-mate Raul Rodriguez Ramos, a Mexican
Pharmacovigilance student from Guadalajara was kind and sweet enough to lend me
his razor so that I could shave my beard off. Early morning when I stepped out onto my hotel room balcony, the sight in front of me was incredibly amazing. View of clean turquoise waters of Caribbean sea, tidy white sandy beaches and tall hotel buildings of Cancun standing in a row, was nothing short of some heavenly abode. All my travel miseries vanished in a jiffy and I found myself in an entirely different frame of mind.
Mexican people and their food:
 |
| Mexican vendors selling handicrafts at Chichen-Itza |
Mexico became a nation in 1821 when it achieved
independence from the Spanish empire that had gained control of Mexico after the conquest of
the Aztec Empire in 1521 A.D by Spanish Conquistador. No surprises then that the most spoken language by
Mexicans is Mexican Spanish. Very few of them speak English. Mexican Spanish is distinct in dialect, tone and syntax
to the peninsular Spanish spoken in Spain. Mexico is the most populous
Spanish-speaking country in the world with 17% of its population living below
Mexico's own poverty line. According to the OECD, worldwide Mexico is the
country with the second highest degree of economic disparity between the
extremely poor and extremely rich, beaten only by Chile. That is probably why drug-trafficking
and narco-related activities are a major concern there. Otherwise Mexican people are known for
their kindness and hospitality. Descendants of the Aztecs and Mayas, they show
great artistic skills as well as pride for their heritage. The vast majority of
the population comprises of Roman Catholics, even though many have incorporated
several of their ancient pagan deities and rituals quite similar to those of
Indian Hindus into their local version of Catholicism. Majority of the Mexicans
are slightly short, well-built, round faced people with short neck, dark
eyes, stout nose, high cheek bones, epicanthic
folds, jet black hair that is thick and straight and mostly turned upwards.
During
lunch on the first day of the conference, we got a taste of the world famous
Mexican cuisine, which, like Mexican people, is highly tied to the Mexican
culture, social structure and its popular traditions. The basic staples remain
the native corn, beans and chili peppers. While it is eaten fresh,
most corn is dried, treated with lime and ground into a dough, which is then used
fresh and fermented to make a wide variety of dishes from drinks (atole, pozol,
etc) to tamales, to sopes and much more. However, the most common way to eat
corn in Mexico is in the form of a tortilla, which accompanies almost every
dish over there. Mexicans are very fond of Tequila, a distilled beverage made from the blue agave plant, often
made at a 38–40% alcohol content. When served neat (without any additional
ingredients), tequila is most often served in a narrow shot glass called a
caballito that means "Little Horse" in Spanish.
Welcome reception and the
Mariachi:
 |
| Mariachi singers performing during welcome reception |
First
day of the conference was dedicated to pre-conference workshop on Basics in
Pharmacovigilance. It was a great
learning experience. In the evening welcome reception was hosted in the moonlit
open air lawns of the conference venue. Highlight of the evening was musical
performance by the Mexican folk singers called Mariachi. The word mariachi was thought to have been derived from
the French word “mariage" (marriage) dating from the French intervention in Mexico in the 1860s, related to the music’s
appearance at weddings. Mariachis wear the charro or traje de charro,
which is a Mexican cowboy suit consisting of a waist-length jacket, bow tie,
fitted pants, short boots and a wide-brimmed sombrero hat. The suits are
elaborately decorated with silver or gold buttons and embroidered designs. Mariachi was recognized
by UNESCO as part of the Intangible Cultural Heritage of Humanity in 2011. We
thoroughly enjoyed the Mariachi performance and they filled the moonlit evening
with warmth and ecstasy.
Salsa lessons for the Pharmacovigilants:
 |
| View of Cancun beach from my hotel balcony |
On second day of the conference at Cancun (literally
meaning nest of snakes) several reputed experts in Pharmacovigilance from
various parts of the world spoke about diverse contemporary topics at length
and discussed latest advancements in the field. It was an intellectually
enriched and content-full day for the participants. Social programme arranged
by the organizers for the second day evening was Salsa dancing lessons from a
Cuban instructor. It was full of fun since many seniors with absolutely no
dancing prowess were seen dancing like jumping-jacks on the Mexican tunes while
trying to learn the salsa steps. It was a dance-with-no-barriers occasion, a
good piece of entertainment for all.
Visit to Chichen Itza - ancient city of Mayan
Civilization:
 |
| In front of the Temple of Kukulcan at Chichen Itza |
On last day of the conference we stole some
time out to visit Chichen Itza, a UNESCO world heritage site that figures
among the new seven wonders of the world as elected on 07.07.2007. Number seven has a lasting spiritual association
with this site. Chichen Itza is a Spanish word meaning “at the mouth of the well of the Itza". The
archaeological site was a large pre-Columbian city built by the Maya
civilization and is presently located in the Mexican state of Yucatán. The buildings of Chichen Itza are grouped in a series of architectonic
sets, and the three best known of these complexes are the Great North Platform,
Temple of Warriors and the Great Ball Court. Dominating the North Platform of
Chichen Itza is the Temple of Kukulkan (a Maya feathered serpent deity),
usually referred to as El Castillo ("the castle"). Every portion of the structure housing temple of Kukulkan (Mayan
pyramid) represents some part of the Mayan calendar that had 18 months in a
year of 20 days each and the remaining 5 days of the year having been
considered by Mayas as inauspicious days when their gods would fight against
the devils. Each of the temple’s four sides has its own
stairway. When counting the 91 existing steps in each face, plus a central step
that is on top of the building, you get 365 steps, the exact number of days in
a year. This and many more details indicate the precision of the Maya with
regards to the study of the sun, the moon, the planets and the stars. Mayans used to construct another temple over an already existing one
every 54 years with similar shape and structure as the earlier one, leaving the
previous one intact. A loud clap evokes different kinds of interesting
reverberations at this point including bird sounds. On the spring and Autumn
equinoxes, in the late afternoon, the northwest corner of the pyramid casts a
series of triangular shadows against the western balustrade on the north side
that evokes the appearance of a serpent wriggling down the staircase. During such
times thousands of Mexicans throng this site to visualize the phenomenon.
Deadly Mayan Ballgame:
 |
| Live performance of the Mayan Ballgame by artists at Xcaret |
There is a Great Ball Court about 150 metres
to the north-west of the Castillo for playing the Mesoamerican ballgame, a game
that is not played using hands or feet but in which solid balls made of rubber
and weighing around 4 Kgs are pushed using only hips and struck into the stone
ballcourt goals fixed at a height of around 5 meters. At the base of the high
interior walls of the ball court are slanted benches with sculpted panels of
teams of ball players. In one panel, one of the players has been decapitated;
the wound emits streams of blood in the form of wriggling snakes. Decapitated
player is the winning captain who has been sacrificed to please and invigorate
the Mayan gods. This was the saddest part of the Mayan story that made us melancholic
and depressed. Even more saddening was the fact that Mayan people used to
sacrifice children in a nearby well called Cenote Sagrado during situations
like drought to please their gods. The Tzompantli, or Skull Platform
(Plataforma de los Cráneos), was the place where decapitated head of the
winning captain would be erected over a stick until it turns into a skull. Chac-Mool is the name given to a type
of Pre-Columbian Mesoamerican stone statue that depicts a human figure in a
position of reclining with the head up and turned to one side, holding a tray
over the stomach, believed to be used for human sacrifice by the Mayans. Behind
the temple of Kukulcan is the temple of thousand pillars used by Mayans for
trade, religious and social congregations. Visit to Chichen Itza is a
historian’s dream and a common man’s delight.
Musical Show at Xcaret, Riviera Maya:
 |
| Dramatic depiction of conquest by Spanish conquistador |
Social programme on the third day of
the conference was arranged by the organizers at Xcaret, a majestic archaeological park located in Riviera Maya, Cancun
in the Mexican
Caribbean Sea shore where we enjoyed a show at night, with more
than 300 actors on stage, resulting in a musical journey through the history of Mexico
since pre-Hispanic times to the present day, with all the colourful costumes,
folklore and dancing. Actors posing as inhabitants of
the pre-Hispanic world greeted us with aromatic copal resin incense and the
beating of drums. A nocturnal bird
emerged from the darkness of a cave to tell its story in the form of a dance. Xcaret Park Riviera Maya presented a
live performance of the Mayan ball game,
a cosmic metaphor between warriors from heaven and the underworld.
Day of the Dead
celebrations:
 |
| Beautifully coloured Katrina la Meurte |
As in many Latin American countries, Mexico commemorates El Dia de los
Muertos - the Day of the Dead or All Soul’s Day on November 2nd,
every year. Our visit to Xcaret coincided with the Day of the Dead celebrations
there. The legacy of past civilizations is graphically manifested on this
occasion through people’s beliefs that death is a transition from one life to
another in different levels where communication exists between the living and
the dead. Despite the morbid subject matter, this holiday is celebrated joyfully
and the emphasis is on celebrating and honoring the lives of the deceased,
rather than fearing evil or malevolent spirits. It is common practice to keep
skulls known as “Katrina la Muerte” as
trophies and display them during rituals to symbolize death and rebirth. On ‘Day of the Dead’, foods such as
tamales and mole are set out on altars with lots of other eatable offerings and
it is believed that the visiting dead relatives “eat” the “essence” of the
food. If eaten afterwards by the living it is considered to be tasteless. Apart from the scintillating and mesmerizing musical
and dramatic performances by folk artists inside Xcaret on the Day of the Dead
that we enjoyed to the hilt while having cold drinks, dinner, desert etc right
on our seats, whole ambience around Xcaret theatre that night was magical. Numerous stalls had been
erected with people wearing ancient Mayan costumes, painting their faces like
dead, singing, dramatizing, praying and offering eatables on altars. It was a
different world altogether whose imprints will remind indelible on my mind for
a long time to come.
Pre-Conference
Workshop on "Basics in Pharmacovigilance" (October 30th, 2012)
 |
| Presenting my poster on first day of the conference |
Programme was very
interesting as well as informative and quite useful presentations were made by some
renowned experts in Pharmacovigilance like Ulrich Hagemann, Deirdre McCarthy,
Saad Shakir, Marie Lindquist, Eugene Van Puijenbroek, Rachida Soulaymani, Souad
Skalli, Nicholas Moore and Luis Alesso on various topics of Pharmacovigilance
like Principles of risk management, ICH and CIOMS guidelines, Cohort event
monitoring, Medication errors, Signal detection, Risk communication, Herbal
Medicine Safety, Developments in Pharmacoepidemiology and Counterfeit
medicines. All presentations of the course were followed by interactive
sessions and the deliberations were quite stimulating. Whole course was
organized well and conducted in a punctual manner. In nutshell it was a great
learning experience wherein participants could update their knowledge and
understanding about various issues pertaining to drug safety.
Main
Conference: (October 31st to
November 2nd, 2012)
 |
| My oral presentation on third day of the conference |
All sessions of the
main conference attended by me were highly relevant to the contemporary issues
in pharmacovigilance wherein erudite presentations were made by some reputed
stalwarts in this field that provided me with a great opportunity to expose and
update myself to the latest advancements and recent trends in drug safety and
efficacy management. Greater emphasis was laid upon post-authorization safety
and efficacy studies, impact of new EU post-licensing legislation on
pharmacovigilance, pharmacovigilance in pediatrics, women and reproductive
health, ecopharmacovigilance, pharmacovigilance in hospitals, communication in
pharmacovigilance, signal detection and evaluation and upon regional and global
developments in pharmacovigilance. Conference helped me to a great extent in deciding
my future research goals and in propagating the renewed knowledge and
experiences gained to my students, scholars and colleagues back in my own University.
I look forward with keen interest to apply the methodologies and concepts
shared through poster presentations of the conference back in my own local
settings in days to come. It was a content-full and
substantially enriched conference for me that will positively and considerably
impact upon my regular teaching and research work back home.
Valediction of the
Conference:
 |
| Tulum A: Main conference hall of the conference |
My oral presentation was scheduled on the last day of the conference
whereas I had presented my poster on the very first day. Both of my
presentations were well received and I answered lot many questions. My return
journey was quite pleasant in spite of being tiresome and well on time since
the impact of hurricane Sandy had completely subsided by then and flights were
operating as per schedule. It was a memorable trip to sum it all.
(Author is working as Senior
Assistant Professor at the Department of Pharmaceutical Sciences, University of
Kashmir and can be reached at ishaqgeer@gmail.com)
