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Traditional Medicine is now a Proven Remedy

By David SouthDevelopment Challenges, South-South Solutions

SOUTH-SOUTH CASE STUDY

Once dismissed as old fashioned, ineffective and unscientific, traditional medicine is now seen as a key tool in bringing healthcare and healing to poor people bypassed by existing public and private health measures.

Acknowledging traditional medicine as a useful tool goes back to the World Health Organisation’s Alma-Ata Declaration in 1978, which urged governments for the first time to include traditional medicine in their primary health systems and recognise traditional medicine practitioners as health workers. During the last 30 years there has been a considerable expansion in the use of traditional medicine across the world. Despite their ancient origins, it is still critical these medicines do meet efficacy and health standards and are proven to work.

In Mongolia, when the Soviet Union collapsed a decade and a half ago, new market forces meant that supplies of conventional medicines became prohibitively expensive for most of the population. With one doctor for 600 people in the rural areas – and the vast distances to be covered – medical services were virtually unobtainable in rural communities.

This situation led to a revival of Mongolia’s 2,000-year-old traditional medicine. This includes acupuncture, cauterisation, manual therapy, blood letting and therapies using mares’ milk – all integral to the rural way of life.

Research by the Japanese Nippon Foundation – the largest private foundation in Japan – explored how Mongolia’s public health care could be improved through traditional medicine. It focused on the possible use of traditional medicine alongside Western medicine, the depth of faith in traditional medicine, the affordability of traditional medicine, and the lifestyles of herdsmen living in remote areas away from hospitals. The project, launched in 2004, distributes medical kits with 12 types of traditional medicines to households in rural areas. As they use them, the households pay for them. The kits, which mostly target stomach and intestinal ailments and fever, have so far been distributed to 10,000 households (50,000 people) across the country. The Foundation found doctors’ house calls were down by 25 per cent after one year of the project.

In India, Gram Mooligai and its Village Herbs label helps bring quality healthcare to the country’s 170 million rural poor currently left out by public healthcare programmes, or who can’t afford private services. At present, the Indian government has been unable to find adequate funds to provide healthcare to all its people. Gram Mooligai uses a network of 300 women health practitioners to reach villagers who spend on average US $50 a year on health services – so far, they reach 30,000 households. It has built trust with the poor by offering herbal remedies based on India’s strong Ayruvedic heritage of herbal healing. It also draws on India’s rich biodiversity by harvesting medicines sustainably from native plant species – over 18,000 are known.

The company is owned by a network of rural growers that manufacture herbal remedies like Trigul balm for joint pain, Sugam cough syrup and Jwaracin fever reducer. Gram Mooligai combines modern heathcare with local remedies familiar to rural villagers.

The website gives a good example of this folksy approach. In answer to a villager whose daughter is complaining of pain in her legs and back, the villager is advised to give her milk and ghee (clarified butter). “Add nuts and dry fruits to her daily diet in small quantity. If she is lean, then a weekly massage with Lakshadi Thailam (which is available in the Ayurvedic shops) is very useful. Slightly warm the oil before massage and add a pinch of common salt to the oil for better absorption.”

Published: September 2007

Resources

  • Mongolian Traditional Medicine Website: www.baigal.com
  • Asia-Pacific Traditional Medicine and Herbal Technology Network: an excellent first stop for any entrepreneur, where they can find out standards and regulations and connect with education and training opportunities: www.apctt-tm.net and www.aptm.cn

Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP’s South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South’s innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator.

Creative Commons License

This work is licensed under a
Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

ORCID iD: https://orcid.org/0000-0001-5311-1052.

© David South Consulting 2022

Categories
Archive Development Challenges, South-South Solutions Newsletters

Finding Fortune in Traditional Medicine

By David SouthDevelopment Challenges, South-South Solutions

SOUTH-SOUTH CASE STUDY

Traditional medicines and treatments could help provide the next wave of affordable drugs and medicines for the world. But a phenomenon known as ‘bio-prospecting’ – in which global companies grab a stake in these once-free medicines – has been placing traditional medicines out of reach of Southern entrepreneurs. Pharmaceutical patents (http://en.wikipedia.org/wiki/Patents) taken out by international drug companies are making traditional medicines expensive and inaccessible to the poor.

Indian scientists have identified more than 5000 bio-prospecting patents, worth some US $150 million, taken out by companies outside India.

Now governments in countries like India are moving to protect these recipes and the plants and animals they are made from.

The Indian government has labelled 200,000 traditional treatments as public property and free for anyone to use. These treatments are key parts of the 5000-year-old Indian health system called Ayurvedic medicine (http://en.wikipedia.org/wiki/Ayurveda) – ayur means health in Sanskrit, veda means wisdom.

“We began to ask why multinational companies were spending millions of dollars to patent treatments that so many lobbies in Europe deny work at all,” said Dr. Vinod Kumar Gupta, head of the Traditional Knowledge Digital Library, which lists in encyclopaedic detail the 200,000 treatments.

“If you can take a natural remedy and isolate the active ingredient then you just need drug trials and the marketing. Traditional medicine could herald a new age of cheap drugs,” Gupta told The Guardian..

Currently, it is very expensive to follow the Western approach to developing drugs. A so-called “blockbuster drug” can cost US $15 billion and take 15 years to bring to the market. With patents lasting 20 years, a drug company can have as little as five years to recover its development costs. This helps explain the high prices for drugs.

Unlike traditional healers in the South, multinational corporations can marshal the money, time and legal resources to file patents.

In the past, India has fought expensive and lengthy battles to revoke patents on traditional remedies. One example is the battle over the popular Indian spice turmeric powder (used for healing wounds, among other things). A patent awarded to the University of Mississippi in 1995 was successfully withdrawn after a legal battle by the Indian government.

The Indian government’s move to make traditional medicines and therapies public property promises to unleash a new wave of natural remedies and drugs and to expand the market for Southern health entrepreneurs drawing on traditional knowledge and recipes.

As the world’s economy continues to suffer, finding new ways to earn incomes and spark a whole new generation of businesses will be crucial to recovery.

The World Health Organization (WHO) defines traditional medicine as “the sum total of knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures that are used to maintain health, as well as to prevent, diagnose, improve or treat physical and mental illnesses.”

The importance of traditional medicines in primary health care can be seen in Asia and Africa, where its usage reaches 80 percent of the population in some countries (WHO). Herbal medicines alone are worth billions of dollars a year in sales. Examples of traditional remedies include antimalarial drugs developed from the discovery and isolation of artemisinin from Artemisia annua L., a plant used in China for almost 2000 years. In 2003, doctors found scientific evidence supporting the use of traditional Ghanaian plants to help wounds heal. Parts of the African tulip tree and the Secamone afzelli are made into pastes which are applied to wounds.

The downside of traditional medicine is the urgent need for better regulation and safety standards. While more than 100 countries have regulations for herbal medicines, counterfeit, poor quality or adulterated herbal medicines are still a major problem.

Herbal treatments are the most popular form of traditional medicine, and are highly lucrative in the international marketplace. Annual revenues in Western Europe reached US $5 billion in 2003-2004.. In China, sales of products totalled US $14 billion in 2005. Herbal medicine revenue in Brazil was US $160 million in 2007 (WHO).

One initiative is ensuring there is a solid future for traditional medicine in India. Charity Bodytree India, set up in 2004 by a group of health, human rights and education workers, addresses issues surrounding access to health care and the disappearing traditional medical practices amongst isolated indigenous communities. Bodytree has established a successful educational programme that trains young people from different indigenous communities to become community health workers and operates programmes of health education for community groups (http://www.bodytree.org/index.html).

Almost four-fifths of India’s billion people use traditional medicine and there are 430,000 Ayurvedic medical practitioners registered by the government in the country. The department overseeing the traditional medical industry, known as Ayush, has a budget of 10 billion rupees (US $260 million).

In the state of Kerala in India’s South, Ayurveda medical tourism has become a good income generator. And it is so popular in the nearby nation of Sri Lanka, hotels can have Ayurveda included in the name.

Indian entrepreneurs are drawing on increasing awareness of the importance of healthy living and rising interest in vegetarian diets – what were once holidays are now health experiences. With global obesity rates rapidly rising, along with the attended diseases like cancer and diabetes, more and more people are looking for a dramatic change to their eating and lifestyle habits to ensure long-term health. And traditional medicine has solutions.

Published: March 2009

Resources

Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP’s South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South’s innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator.

Creative Commons License

This work is licensed under a
Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

ORCID iD: https://orcid.org/0000-0001-5311-1052.

© David South Consulting 2022

Categories
Archive id magazine

Will Niagara Falls Become The Northern Vegas?

By David South

Id Magazine (Canada), May 16-29, 1996

Niagara Falls – Niagara Falls has always been a town that attracted big dreamers with even bigger schemes. The beauty of the Falls has intoxicated many with grand ideas. Towards the turn of the century, the inventor of the Gillette safety razor, King Camp Gillette, tried to transform the American side into a Utopian paradise, planning to house most of the US population in a community of beehive-style high-rises covering an area 135 miles long and 45 miles wide.

Given the long history of grand schemes to remake both sides of Niagara Falls, it is hard not to see the hyperbole surrounding the planned casnio, slated to open by the end of the year, as another over-hyped dream. Just as Gillette spoke of untold riches, the government-owned Ontario Casino Corporation also sees Utopia ready to be born at the edge of the Falls. As provincial tourism minister Doug Saunderson said last month, “The casino and tourist development will provide Niagara with a kick start into the 21st century… I believe they will move Niagara to the very top of the list of destinations for world travellers.”

Those expectations sound even more impressive if you believe the government’s estimates for job creation. In a city of 76,000, the government projects between 3,000 and 9,000 jobs will result from the casino and its spin-offs. With numbers like that, it is hard to find many people who will say no.

Everywhere in Niagara Falls’ tourist district roads are being ripped up. Tourists from New York, Japan and Quebec tread through the clouds of gravel dust to see the Falls. But it isn’t just the government which is dreaming big for Niagara Falls.

Three dreams are fighting in this town for the hearts and souls of its residents, and depending on your perspective, have their merits. One, a scheme being championed by a group of local church leaders, is to build a wholesome theme park based around the exploits of local heroine Laura Secord during the War of 1812. Another more flamboyant scheme that has been on and off again since 1993, involves building a $1.4 billion theme park dedicated to transcendental meditation. So far, the casino is winning hands down.

The casino on its own is helping to raise another dream, phoenix-like, from the ashes. In 1979, the DiCenzo family built Maple Leaf Village as a joint shopping mall/theme park attraction. Now it sits derelict, waiting for renovations by the Buttcon construction company to turn it into the temporary site for the casino.

The run-down Maple Leaf Village, with its old-world European facade resembling a castle, became known for tacky attractions like the JFK Assassination Museum, the Elvis Presley Museum and the Nightmares Therapy Centre.

Judy MacCarthy has fought plans to build a casino since they were first discussed. She helped put together a coalition of church groups called the Try Another Way Committee. MacCarthy’s dream involves a theme park extolling the virtues of Laura Secord, whose claim to fame was snitching on the American invaders, having them ambushed by Indians near Niagara Falls.

MacCarthy says the provincial government has shown some interest in the project, even sending officials from Toronto to meet with her.

As for the more ambitious transcendental meditation theme park, it looks as if the whole project hangs on securing enough funds to get it off the ground.

In 1993, Maharishi Veda Land’s chair, the effervescent magician Doug Henning, told the media that Niagara Falls had to make up its mind: choose between the transcendental theme park, with its centre-piece floating bridge, or the moral decadence of a casino.

Three years later, what many thought to be a project even less tangible than Henning’s metaphysical musings, seems to still have some life left. Tucked away on the 13th floor of a Bay Street office tower in Toronto, Maharishi Veda Land Inc. – Enlightenment, Knowledge, Entertainment – continues to run with a handful of staff. As three office workers scatter behind closed doors, a secretary tells me the theme park is still a go, but refuses to give any more details. But MVL has told a Florida newspaper it isn’t going to build a theme park on property the company owns there.

Tucked away on the 13th floor of a Bay Street office tower in Toronto, Maharishi Veda Land Inc. – Enlightenment, Knowledge, Entertainment – continues to run with a handful of staff. As three office workers scatter behind closed doors, a secretary tells me the theme park is still a go, but refuses to give any more details.

Ted Cook, the former vice-president of PCL Eastern, the construction company Henning contracted to build the park, says there was a change in attitude: “Henning’s position softened as time passed (over the casino). He became less opposed on moral grounds, and it was now ‘maybe we can make it work’.”

If there was an epicentre to the Niagara dream machine, it is the office of its mayor, Wayne Thompson.

Dean Iorfida is the mayor’s executive assistant. For Iorfida, the casino is a matter of turning a seasonal economy dependent on summer-time tourists into a viable year-round attraction. Even when they do come to Niagara Falls, he says, the average tourist’s stay is just four hours.

Iorfida is dreaming large, imagining the permanent site will include an auditorium, convention centre and amusement park. “Vegas has gone that way,” he says.

But he also wants to see the whole city transformed by the casino. “We have to spread it around or you get a black hole effect: too much in one location.”

As for the complaints that the casino will only add to the tacky reputation of Niagara Falls, Iorfida believes “the city doesn’t want anything that turns people off, but we can’t stop private enterprise. We are talking about one location, I don’t think it will be like Vegas where casinos try to out-garish each other.”

Many associated with the traditional tourist attractions in Niagara are banking on seeing some of the casino cash. Merchants on Clifton Hill, “The street of fun at the falls,” are hoping they can complement the casino rather than compete.

So far, the tourist trap, despite the shabby strip of Clifton Hill with its wax museums and fudge shops, or even the block after block of cheap hotels and motels, has been able to avoid turning into a seedier form of sleaze – it is still a family atmosphere. In fact, the declasse’ tone of the city hides an impressive stability and prosperity that makes the residents of Niagara Falls, New York jealous. For many opposed to the casino, it is this stability that is at stake.

Overhead is the dayglo pink and turquoise marquee of the Movieland Wax Museum, where one can see wax likeness’ of such luminaries as Jim Carrey. Guy Paone, the general manager of the museum, says he is happy about the casino, hoping it will bring year-round business.

“We get families down here,”he says. “If dad wants to go to the casino, then mom and the kids can come here.”

Paone isn’t expecting any business from the die-hard gamblers though. “The hard-core gamblers didn’t come here any way. You know how it is – in Vegas some people don’t eat or sleep.”

As for some of the doom and gloom about increasing crime scaring off the family tourists, Paone doesn’t buy it. “We are pretty tight on petty crime here. I don’t think the casino will affect the family reputation.”

Paone does have a sobering thought he leaves me with, “we are the suicide capital.”

All the hope has already spawned new jobs teaching the unemployed how to gamble. Frank Cricenti, black jack course co-ordinator at the National Casino Academy, joins a growing number of people employed in the lucrative business of teaching the unemployed casino skills. According to Cricenti, casino schools “are just popping up.” At government employment centres, staff are anticipating more than 100,000 applications to flood in chasing the 3,000 jobs being offered. Such a yawning chasm between expectations and reality means times are good for the adult education business.

At the 47-room Cataract Motel, the casino is an excuse to spiff the place up. “We have painted and renovated the rooms so that they look like they’re brand new,” says the motel’s manager, who will only give his name as B. John.

Other property owners are banking on the casino rescuing them from the slump. Eva Klein of Klein Developments, wants to especially unload her pricier properties. “There has been a little bit of change in the rental market, some casino people are moving into town,” Klein tells id. “We’ve had a high vacancy of higher-end rentals in Niagara Falls and we’re expecting these to be filled by a new influx from the casino.”

For Niagara Falls, the casino looks set to turn the city into a smaller, more Canadian Las Vegas. For a city desperate for more work, that doesn’t sound too bad. For the provincial government’s travelling road show, the next stop is to move the existing Windsor casino’s management over to staff the new casino at Niagara Falls.

Casino Calamity: One Gambling Guru Thinks The Province Is Going Too Far

https://davidsouthconsulting.org/2020/06/16/casino-calamity-one-gambling-guru-thinks-the-province-is-going-too-far/

CASE STUDY 3: Id Magazine | 1996 – 1997

https://davidsouthconsulting.org/2021/07/20/case-study-3-id-magazine-1996-1997-2/

A visionary ahead of his time, we now see the Channel Zero concept everywhere, from You Tube to Tik Tok.

https://davidsouthconsulting.org/2021/02/07/cock-tales-too-much-for-hamilton/

https://davidsouthconsulting.org/2020/11/17/land-of-the-free-home-of-the-bored/

https://davidsouthconsulting.org/2020/12/22/man-out-of-time-the-world-once-turned-on-the-ideas-of-this-guelph-grad-but-does-the-economist-john-kenneth-galbraith-know-the-way-forward/

https://davidsouthconsulting.org/2021/01/20/pulling-the-plug-on-hate-rock-1996/

https://davidsouthconsulting.org/2021/01/16/redneck-renaissance-a-coterie-of-journalists-turn-cracker-culture-into-a-leisure-lifestyle/

https://davidsouthconsulting.org/2021/01/14/from-special-report-sexual-dealing-todays-sex-toys-are-credit-cards-cash-a-report-on-the-sex-for-money-revolution/

https://davidsouthconsulting.org/2020/12/11/tvs-moral-guide-in-question-again/

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This work is licensed under a
Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

ORCID iD: https://orcid.org/0000-0001-5311-1052.

© David South Consulting 2023

Categories
Archive

Cashing in on Old Wisdom

By David SouthDevelopment Challenges, South-South Solutions

SOUTH-SOUTH CASE STUDY

India’s traditional weavers, heirs to a 2,000-year-old textile industry, are turning to the ancient practice of ayurvedic medicine to make their products more appealing and boost sales. Drawing on recipes once used by weavers to the Indian royal courts, clothes are woven and infused with ayurvedic, herb-and-spice medicinal recipes to address various health problems. Strange as it may sound, the health-giving properties of the clothes have been backed up by clinical trials at the Government Ayurveda College in Thiruvanathapuram, southern India.

The college claims the trials were successful for 40 patients with rheumatism, allergies, hypertension, diabetes, psoriasis and other skin ailments. It is believed the healing properties of the herb-and-spice-infused clothes enter the skin and contribute to healing.

Modern India’s founding father, Mahatma Gandhi, championed hand-spun cloth and weaving. But India’s weavers have been hit hard by the rise in the rupee against the dollar and an inability to compete internationally. They are facing stiff competition from a flood of machine-made cheap clothing. According to Siddique Hassan of the Weaver and Artisans Rights Front (WARF), 1 million of India’s 5 million weavers have lost their jobs because of competition (Deutsche Presse-Agentur).

But rising interest in sustainability and natural healing is creating a growing global market for organic clothes – sales are set to triple to US $2.6 billion in 2008 (Organic Exchange).

Against this backdrop, local governments have turned to traditional ayurvedic medicine to help save the livelihoods of handloom weavers and develop a market niche for their eco-friendly fabrics.

In the technique called Ayurvastra, the clothes are dyed with herbal essences, infusing the cotton with the medicine. More than 200 herbs are used, mostly taken from roots, flowers, leaves, seeds and bark. Most of the clothes are made with cotton and silk, and some with wool and jute. A dress is marketed to people who suffer from hypertension. There are bedcovers, pillow covers, nightgowns, and even suits. It is believed the healing effect is best when the patient is sleeping.

The clothes are made in Balaramapuram, home to traditional weaving in Kerala, southern India, and sell for between 1,000 and 1,800 rupees (US $25 to US $45). Ayurvastra clothing is currently being exported to the Middle East, the US, Italy, Germany, Britain, Singapore, Malaysia and Jordan.

Acknowledging traditional medicine as a useful development tool goes back to the World Health Organisation’s Alma-Ata Declaration in 1978, which urged governments for the first time to include traditional medicine in their primary health systems and recognise traditional medicine practitioners as health workers. During the last 30 years there has been a considerable expansion in the use of traditional medicine across the world. Despite their ancient origins, it is still critical these medicines do meet efficacy and health standards and are proven to work.

Ayurvastra is a branch of the 5,000-years-old Indian ayurveda health system. Ayur means health in Sanskrit, veda means wisdom, and vastra is cloth or clothing. There are no synthetic chemicals and toxic irritants and the technique uses organic cotton that has been hand loomed.

“The entire process is organic,” said K. Rajan, chief technician at the Handloom Weavers Development Society in India, to Zee News. “The cloth is bleached with cow’s urine, which has high medicinal value. The dyeing gum too is herbal. It does not pollute like synthetic dye. And the waste is used as bio manure and to generate bio gas.”

Chaitanya Arora of Penchant Traders, an Indian company promoting and exporting ayurvastra cloth and clothing, tells how it works: “usage of the cloth is based on the principle of touch. By coming in contact with ayurvastra, the body loses toxins and its metabolism is enhanced.”

One clothes buyer, T D Kriplani, told Zee News, “Basically, I have read about the concept in newspapers… I was inquisitive and have also heard that it is in direct touch with body pores. I have come here after reading about it and hope it will benefit people.” It is even claimed the clothes can keep people cool.

Another seller of ayurvastra, Hitesh, is enthusiastic about its impact: “The medicinal clothes that we have launched is a new revolution in the textile industry. In there, we dye the clothes with ayurvedic dyes and the clothes have medicinal qualities, which hopefully are good for diseases.”

Published: February 2008

Resources

  • Think! Clothing: A stylish UK-based designer using fair-trade, hand woven clothes from Indian women from the ‘untouchable’ caste.
  • An online shopping site based in Kerala, India offers a wide range of the ayurvastra clothing: http://www.ayurvastraonline.com/
  • Fibre2Fashion: An excellent web portal can be found here to connect weavers with the wider fashion industry – basically an online marketplace for making deals.
  • Asia-Pacific Traditional Medicine and Herbal Technology Network: an excellent first stop for any entrepreneur, where they can find out standards and regulations and connect with education and training opportunities: www.apctt-tm.net

Creative Commons License

This work is licensed under a
Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Southern Innovator was initially launched in 2011 with the goal of inspiring others (just as we had been so inspired by the innovators we contacted and met). The magazine seeks to profile stories, trends, ideas, innovations and innovators overlooked by other media. The magazine grew from the monthly e-newsletter Development Challenges, South-South Solutions published by the United Nations Office for South-South Cooperation (UNOSSC) since 2006.

Issue 6’s theme has been decided on: it will focus on Science, Technology and Innovation. For this issue, Southern Innovator is seeking invitations from cutting-edge knowledge and science innovators in the global South to view their work. Time is tight, so don’t miss this opportunity to let the whole global South know about your work. In the past, Southern Innovator has visited green pioneers in Cuba, a smart city in South Korea and an eco-city in China.

Contact me if you wish to receive a copy/copies of the magazine for distribution. Follow @SouthSouth1.

Southern Innovator Issue 1

Southern Innovator Issue 2

Southern Innovator Issue 3

Southern Innovator Issue 4

Southern Innovator Issue 5

Southern Innovator Issue 6

Innovator Stories and Profiles

Citing Southern Innovator

Finding Southern Innovator

Press Release 1

Press Release 2

Press Release 3

Southern Innovator Impact Summaries | 2012 – 2014

ORCID iD: https://orcid.org/0000-0001-5311-1052.

© David South Consulting 2021