The waiting game: where are the world’s worst port delays?

From Shenzhen to Los Angeles, storms, Covid and labour shortages are causing disruption

Gill Plimmer and Harry Dempsey

The Kwai Chung container port in Hong Kong: the backlog off southern China is currently the world’s worst © Marc Fernandes/NurPhoto via Reuters

The nearly 100 ships waiting on the horizon to berth at the Hong Kong and Shenzhen container ports are just the latest sign of the problems to have snarled global supply chains, pushed up consumer prices in Europe and the US, and led to shortages of goods ranging from Christmas toys to furniture.

The backlog off southern China is currently the world’s worst. 

A typhoon closed the ports for two days this week — but although weather often disrupts shipping, this just added to the problems from previous jams since the pandemic began. 

In August, a single Covid case paralysed a terminal for a fortnight in the major Chinese port of Ningbo, outside Shanghai.

Globally, there are now 584 container ships stuck outside ports, nearly double the number at the start of the year, according to real-time data from Kuehne+Nagel, one of the world’s largest freight forwarders.

“Supply chains have been hit from all angles and have broken down to an unprecedented level,” said Simon Heaney, an analyst at maritime consultancy Drewry. 

“The problems are much more deep-seated than what you see at the ports.”

Increased demand for consumer products, Covid-induced disruption to container ship schedules and a shortage of port workers and truck drivers have all combined to extend waiting times at ports.

Adding to the problem is that when ships arrive at their destinations later than expected, cargo operations and turnround schedules are knocked out of sequence, causing a ripple effect of disruption on freight, truck and warehouse services.

The snarl-ups in supply chains are reflected in a surge in shipping costs: the average global price of shipping a 40 foot container is now close to $10,000, three times higher than at the start of 2021 and almost 10 times pre-pandemic levels, according to Freightos.

Detlef Trefzger, chief executive of Kuehne+Nagel, expects the congestion in sea freight will last at least until the beginning of Chinese new year in February and may get worse before then. 

Others believe that the crisis could last longer — especially if weather is bad or there are more coronavirus outbreaks in China, given its zero-Covid policy.

“We’re getting into the winter period in the northern hemisphere that will bring a return to normal challenges — snow, wind and the closures of terminals. 

Then we don’t know what will happen,” said Lars Mikael Jensen, head of global ocean network at Maersk. 

“I can’t judge if we’re over the worst.”

In Europe, there are long waits for ships outside Hamburg and Antwerp. 

Even when vessels do not have to wait for days at sea, there can still be huge disruptions — as at Rotterdam port in the Netherlands and at Felixstowe in the UK, where shortages of truck drivers or clogged inland waterways slowed the onward movement of cargo.

On Thursday, Felixstowe remained the hardest hit UK port, with two ships at anchor waiting for a berth. 

Maersk, the biggest shipping company, has diverted some of its UK bound cargo to Europe, where it can be shifted to smaller vessels for transport to the UK.

Similar logistical problems have hit ports on the west coast of the US. 

Although the number of ships waiting at sea has fallen from a record 76 in September to 57 now, shortages of port workers and truckers means it takes up to 12 days for ships to drop anchor and unload containers, delaying the delivery of everything from sneakers to tropical fruits and Lego.

That is why it takes three times longer compared with pre-pandemic times to clear vessels at Los Angeles and Long Beach. 

By contrast at large Chinese ports, which work 24 hours a day, seven days a week, it only takes 20 per cent longer, according to IHS Markit’s port performance programme, an industry data set.

The problem is so severe that US president Joe Biden has been pushing rail freight companies, trucking groups and ports to increase their capacity. 

Large businesses including Walmart and UPS have meanwhile pledged to step up their efforts to move goods.

Lars Jensen, a container shipping analyst at Vespucci Maritime, said that even when problems start to ease, port bottlenecks will still come in fits and starts everywhere as delayed vessels try to dock all at once.

“Nobody should expect this to be a gradual and smooth transition,” he said. 

“You’re going to have these back and forth ripples that will take a while to get out of the system.”

Latin American Migration, Once Limited to a Few Countries, Turns Into a Mass Exodus

Haitian standoff in Texas reflects broader mix of nationalities fleeing pandemic-hobbled economies from around the hemisphere

By Juan Montes, Ryan Dube and Kejal Vyas

Migrants, many from Haiti, cross the Rio Grande River near Ciudad Acuña, Mexico. CHRISTOPHER LEE FOR THE WALL STREET JOURNAL

CIUDAD JUÁREZ, Mexico—The gathering of thousands of Haitians at the Texas-Mexico border this past week reflects a stark change in migration patterns to the U.S., driven by Covid-19.

A far broader mix of nationalities is turning up at the border than in the past. 

For decades, most crossers were Mexican men and, in recent years, families from the troubled Central American countries of Guatemala, Honduras and El Salvador, known as the Northern Triangle.

Suddenly Ecuadoreans, Brazilians, Nicaraguans, Venezuelans, Haitians and Cubans are turning up by the hundreds of thousands, a trend that accelerated sharply in the past six months.

From October 2020 through August, nearly 300,000 migrants from countries other than Mexico and the Northern Triangle were encountered at the border, a fifth of all crossings. 

For all of fiscal 2020, when the pandemic slowed the flow of migrants, the figure was nearly 44,000, or 11% of crossings. 

In fiscal 2019, it was 77,000, or 9% of crossings; and the year before it was only 21,000, or 5%. 

As recently as 2007 such migrants represented less than 1%.

Among the fastest-growing groups are Haitians. 

From October of last year through this August, about 28,000 Haitians were arrested trying to cross the U.S.-Mexico border. 

That is six times the 4,400 arrested during the entire 2020 fiscal year that ended last September.

The broad wave includes single mothers from Ecuador, Nicaraguan teenagers and farm laborers in Chile. 

Many cite the same reasons for uprooting their lives and heading north: economic hits from the pandemic that cost jobs and income, the allure of a booming U.S. economy and the belief that President Biden’s administration would welcome them.

“We’ve never experienced anything like this before,” said Austin Skero, who retired this summer as chief patrol agent for the U.S. Border Patrol in the agency’s Del Rio Sector in South Texas. 

“All of these folks who are kind of surging in Del Rio proper, groups of 150, 100. 

It’s a mix of Haitians and Cubans, or Venezuelans and Cubans.”

In July and August, migrants from other countries in Latin America and the Caribbean as a group outpaced those from either Mexico or individual countries from the Northern Triangle for the first time

Volunteers hand out supplies to migrants in Ciudad Acuña. / PHOTO: SERGIO FLORES FOR THE WALL STREET JOURNAL

The influx poses a challenge for the Biden administration. Encounters of migrants at the U.S.-Mexico border are near a 20-year high. 

Border apprehensions are expected to reach about 1.7 million this year, twice the number from 2019. 

It is unknown how many cross undetected.

The administration this week sent hundreds of Customs and Border Protection agents to stabilize the border and try to keep more migrants from entering. 

It began deporting Haitians at the border in flights back to their home country.

Many of those apprehended are currently being sent back across the border under a public health authority known as Title 42 that both the Trump and Biden administrations have argued allows the U.S., during a public health emergency, to deny migrants’ rights to request asylum. 

Some, usually with small children, are allowed to enter and ask for asylum, adding to an already-overwhelmed asylum system.

More than 9 in 10 of the migrants from other countries come from just six Latin American nations: Ecuador, Brazil, Haiti, Cuba, Nicaragua and Venezuela.

Migrant families arriving at Bajo Chiquito camp after walking through Panama's Darien jungle for several days.

Struggling to put food on the table after the pandemic closed her small coffee business, Mayra Aguilar sold her car and left her home in Ecuador’s southern Andes last month, hoping for a better life in the United States.

Ms. Aguilar and her 4-year-old son crossed the Rio Grande and turned themselves over to the U.S. Border Patrol, believing they would be welcomed after her smuggler said the border was open for migrants. 

Instead, they were apprehended and sent back to Mexico, leaving the single mother broke and depressed, living in a shelter in this violent border city filled with other migrants.

“I was cheated. I thought I would be able to stay in the U.S., but it was a total lie,” said Ms. Aguilar.

The number of Ecuadorean migrants encountered by U.S. border officials since last October hit 88,342 through August, compared with 13,000 in the 2019 fiscal year and just 1,495 in 2018.

Latin America and the Caribbean as a whole suffered the world’s steepest economic contraction last year, and the region’s biggest decline since the Great Depression, according to the International Monetary Fund. 

The pandemic cost some 26 million jobs.

“After the pandemic, what we are now seeing is like a pressure cooker in which the valve has exploded,” said Enrique Vidal, coordinator of Fray Matías de Córdoba Human Rights Center, a pro-migrant nonprofit in Mexico. 

“It’s a humanitarian drama.”

Even when the pandemic recedes, the new migration patterns will likely persist. 

Immigrants to the U.S. often create a network of pathways that spur new migrants to head north, as those who succeed provide advice to family and friends, causing word to spread, immigration experts say.

Sidmar Pereira, a 34-year-old Brazilian, hopes to reach Massachusetts and join his cousin, who settled there with his entire family. 

Last month, Mr. Pereira flew with his wife and three children from São Paulo to Mexico City and then traveled to Ciudad Juárez. 

He’s now waiting with his family in a shelter for the U.S. to resume processing asylum requests at the international bridge, which was suspended during the pandemic.

He says he would like to work in one project tied to President Biden’s proposed $1 trillion infrastructure plan. 

“They don’t have enough workers,” he said of U.S. companies, “and we are doing nothing here in Mexico.”

Other migrants are fleeing political repression as crackdowns intensify in Cuba, Venezuela and Nicaragua, Latin America’s three authoritarian regimes. 

Some 37,000 Venezuelans were arrested at the border up to August, compared with 2,200 in all of 2019 and just 62 in 2018. 

Apprehensions of Cubans jumped to 33,000, compared with 11,600 in 2019.

About 42,500 Nicaraguans, who traditionally migrated to neighboring Costa Rica, were apprehended, more than tripling arrests for the whole of 2019 and surpassing migration from Salvadorans for the first time in July.

“In Nicaragua, our fate is prison or death,” said Cristhian Espinosa, a 19-year-old Nicaraguan who hoped to get asylum in the U.S. after saying he received death threats from a pro-government paramilitary group. “We need help.”

At the start of the pandemic, experts expected more migration from poor countries hit by rising poverty and hunger. 

The outflow was initially stemmed because of closed borders and strict lockdowns. 

The downturn in the U.S. economy also curtailed interest in traveling north.

But with borders opening back up and lockdown measures lifted, migrants are on the move, attracted to an improving U.S. economy. 

Desperate for a better life, they are being encouraged by coyotes—or human smugglers—who are operating in more countries around the region, said Blanca Navarrete, the director of a pro-migrant nonprofit in Ciudad Juárez.

“They often mislead vulnerable people, telling them that the U.S. border is open, when it is not,” she said.

At a Methodist migrant shelter in Ciudad Juárez, across the border from El Paso, Father Juan Fierro, says he’s seeing growing numbers of migrants from much further south than ever before.

“This shelter is increasingly looking like a tower of Babel,” said Mr. Fierro, a folksy, mustached man. 

“You have people coming from more countries than in the past, people with different cultures and different languages.”

While thousands of Haitian and other migrants have already turned up at the U.S. border, there are tens of thousands still on their way, overwhelming border crossings in Colombia, Panama, and Mexico.

In Panama, Haitian migration drove a record 70,000 undocumented migrants from January through August, more than the previous three years combined, according to government figures.

“We can’t answer why a citizen of Haiti living in these countries would decide to sell all his belongings and start such a dangerous trek north with no documents, but this is what’s happening,” said Samira Gozaine, the chief of Panama’s migration agency.

Migrants carry supplies across the Rio Grande River near Ciudad Acuña, Mexico. / PHOTO: CHRISTOPHER LEE FOR THE WALL STREET JOURNAL

Some of the Haitian migrants who turned up in the U.S. recently fled the country after President Jovenel Moïse ’s assassination in July, which has put the country on the brink of anarchy. 

Earlier this month, the U.S. Coast Guard intercepted a boat with over 100 Haitian migrants on board some 18 miles off the coast of Miami’s Biscayne Bay.

But the overwhelming majority in Del Rio had left Haiti in the years after the devastating 2010 earthquake that killed some 200,000 people, moving to South American countries like Chile and Brazil that had lenient immigration rules. 

At the time, economists described it as a new wave of immigration from one developing country to another.

Many of those migrants had been living near the bottom rung of the economy, selling food or footwear at street markets. 

That has made them particularly vulnerable to the economic shock caused by the pandemic.

Chile, one of Latin America’s wealthiest nations, also tightened immigration requirements after receiving hundreds of thousands of Venezuelans, Haitians and Cubans in recent years.

Earlier this year, Yanisleidys Diaz began her trek to the U.S. after she was told she had to leave Chile in 180 days. 

The 39-year-old single mother from Cuba arrived in Chile in 2019 with her two sons, seeking informal work because they lacked a work permit. 

Her oldest boy, 17-year-old Leodan Riveros, worked construction and as a fruit picker at a farm, earning less than minimum wage.

They struggled to make ends meet even before the pandemic. 

Then Ms. Diaz said she was notified by the government that they could no longer stay without residency. 

They sold their furniture and clothes to pay for five bus rides to cross Peru, Ecuador and Colombia.

Yanisleidys Diaz, from Camaguey, Cuba, and her sons Leosdani Ocariz, 11, and Leodan Riveros, 17, at a camp for migrants at the riverside port of Lajas Blancas in Panama. / PHOTO: TARINA RODRIGUEZ FOR THE WALL STREET JOURNAL

Like many other migrants, they tried to exit South America through the Darien Gap, one of the thickest tropical rainforests on the planet, which straddles the border between Colombia and Panama. 

No road passes through the jungle, which is rife with venomous snakes and armed gangs.

Once in the Darien Gap, a gang of eight men attacked them, holding a knife to Ms. Diaz’s 11-year-old son as they rummaged through their backpacks for food and money. 

Now stranded in Panama, Ms. Diaz said she doesn’t know how they will reach the U.S. 

“We’re just humans who are looking for a chance,” she said.

Stevens Saintime’s sister perished in the Darien Gap. Mr. Saintime, a 33-year-old from Haiti, left his impoverished country four years ago and with a brother settled in Santiago, Chile, working illegally for a scrap metal collector. 

Their sister, Jenny, found a job as a cleaner in Brazil’s capital.

Work slowed significantly during the pandemic, making it difficult for Mr. Saintime to pay rent. 

He said he couldn’t afford a lawyer to help him obtain residency papers in Chile.

Mr. Saintime and his sister decided to embark on a 5,000-mile journey to the U.S., seeing it as their last hope for a stable life. 

The siblings met in Peru in early August and took a bus north through Ecuador and Colombia before arriving at the Darien Gap. 

They crossed the jungle with 15 other Haitians.

Armed men attacked the migrants, stealing the $200 that Mr. Saintime was carrying as well as his clothes, leaving him only with the shorts and the Chicago Bulls basketball jersey he was wearing.

Stevens Saintime, a Haitian migrant, at a camp in Panama’s Darien province. / PHOTO: TARINA RODRIGUEZ FOR THE WALL STREET JOURNAL

Tired and dehydrated, the group of Haitians separated. 

Mr. Saintime said he walked ahead to see if he could round up food for his sister, who was getting dizzy and falling behind. 

Later, at a migrant camp in Panama, a travel companion told him that Jenny fainted and stopped breathing. 

She had to be left behind, the companion said.

“I don’t know how I’m going to tell my dad that my sister is dead,” said Mr. Saintime, sitting in an indigenous hamlet in Panama. 

He planned to continue his journey.

Under pressure from the U.S., Mexico reinstated this month a visa requirement for Ecuadoreans, who had been able to fly in as tourists and then head to the U.S. border. 

In the first seven months of this year, seven out of 10 Ecuadoreans who arrived as tourists in Mexico didn’t return home, according to Mexico’s government. 

Mexico is also considering a visa for Brazilians, a Mexican official said.

Meanwhile, Ecuador announced in May that Haitians would need visas for entry. 

In February, Peruvian authorities stopped at least 300 Haitians trying to enter the country by crossing a bridge from neighboring Brazil.

“They arrive here almost every day,” said Quedinei Barreto, an official in the Brazilian border town of Assis Brasil.

Makendy Timouche, a 27-year-old Haitian who also comes from Chile, did make it to the city of Tapachula, one of the last stops in southern Mexico in the long trek towards the U.S. In recent months, Haitians have often outnumbered Mexicans in Tapachula’s main plaza.

Mr. Timouche is awaiting refugee status in Mexico which, he hopes, would allow him to get to the U.S. border quickly and safely. He rents a room with five other Haitians in a poor neighborhood. A couple and their child sleep on a mattress, while Mr. Timouche and two others sleep in sleeping bags.

He spends his days recalling the suffering during the journey north and thinking of his 7-year-old son, who is in Haiti. He hasn’t seen the boy in four years.

“I dream that we reunite in the U.S.,” Mr. Timouche said. “I dream about a normal life together.”

Migrants, many from Haiti, camp along the Del Rio International Bridge near the Rio Grande, Texas. / PHOTO: JULIO CORTEZ/ASSOCIATED PRESS

—Alicia Caldwell in Del Rio, Texas, Luciana Magalhães in São Paulo, Brazil, and Santiago Pérez in Mexico City contributed to this article. 


By Egon von Greyerz

Will the autumn of 2021 be the end of the everything bubble?

Are investment markets very soon coming to the end of market insanity?

Since there is very little sanity left in markets or the in the world economy, we have now reached a point where we must accept madness as sanity, as George Bernard Shaw said:

“When the world goes mad, one must accept madness as sanity; since sanity is, in the last analysis, nothing but the madness on which the whole world happens to agree.”

George Bernard Shaw

Investment markets today are all about instant gratification and getting rich quick.

“Stocks always go up” and so does property in the everything bubble. 

Even the normally boring bond market has had a 40 year rise. 

And then we have the supercharged tech stocks, many of which have gained 1000s of percent in this century

And we mustn’t forget the SPAC stocks (Special Purpose Acquisition Companies) or Blank Cheque Companies where shell companies are used to acquire existing companies to inflate their share price.

None of these things are new of course. 

During the South Sea Bubble in the 1720s for example, companies were formed and capital raised with just the purpose of “Making Money”.

We mustn’t forget the cryptocurrencies which are now worth valued at $2 trillion. 

They were just over $1 billion 8 years ago. 

Is that the bubble of the century like tulip bulbs in the 1600s or is it the money of the future. 

Well, most readers know or can guess my opinion on this!


In a world where everything is based on “get rich quick” neither value investing nor wealth preservation enters the equation. 

Why worry about preserving your wealth when you could have made 14x your money on the Nasdaq since 2009 or 5,000x your investment on Bitcoin since 2011.

Calling tops is a mug’s game. Some of us who look at risk have been worried about the everything bubble economy for quite a while. 

To us, since the end of the Great Financial Crisis in 2009, the world economy and asset markets have been an illusion.

It is as if we are watching a virtual reality game in which some people automatically increase their wealth by millions or even billions of dollars every time they pass GO.

But as the rich are getting richer, the masses are just getting poorer and more indebted.

Although we see the wealth that has been acquired by many as an illusion that will soon evaporate, for the ones who have benefited, this is all very real.

Anyone who believes that these gains are real and sustainable will have the shock of a lifetime in coming years. 

As I showed in a recent article about the End of the US Empire, the wealth of the 400 richest Americans has gone from 2% of GDP to 18% in the last 40 years.

This concentration of wealth is of course spectacular but also very dangerous for the world. 

Trees can always grow taller but they never grow to heaven!


So as Shaw said, we are now in “the madness on which the whole world agrees”.

As I have often stated, I believe that we are at the end of a very major economic cycle. 

Not only are markets insane, but so are deficits, debts and currency debasements.

But also moral and ethical values have now vanished into thin air and been replaced by lies, deceit and the golden calf.

We are now in a very critical period for the world since excesses of the magnitude we are now seeing must be corrected.

Exponential moves in one direction are always corrected. 

And the corrections will be of a similar magnitude to the rise but happen much quicker. 

We are talking about falls of 90% or more in all major asset and debt markets.

Nobody believes such moves are possible with central banks and governments standing by with unlimited money printing combined with new Central Bank Digital Currencies that will save the world.


We must understand that illusions cannot rescue the world economy.  

This despite whatever concoctions central banks or Schwab (World Economic Forum) and his billionaire cronies come up with.

Virtual illusions in the form of fake money or empty promises can never repay debt, nor can they change the laws of nature.

Clearly all these “evil forces” will use their power to orchestrate fake resets to “save the world” in an attempt to tighten their grip on the world economy and the financial system. 

But a heavily indebted and fake system can never be reset in an orderly manner.

In my view, any artificial or fake reset will only have a very limited effect. 

It is just not possible to solve a debt problem with more debt whatever way the PTB (Powers That Be) try to dress it in sheep’s clothing.

So an orderly reset is bound to fail very quickly. 

A new digital Fiat and thus fake currency will not solve the world’s debt problem.

Writing off the debt is just another illusory act. 

If you write off the debt, the assets on the opposite side of the balance sheet will also implode in value. 

And since the debt is leveraging the assets, they will have a very long way to fall.

This is why asset implosions of 90-100% are very likely. 

Few people believe this to be possible but with debt collapsing so will the bubble assets which are all inflated by worthless debt.

We must remember that the big stock market crash in 1929-32 saw the Dow lose 90% of its value. 

It then took 25 years for the Dow to get above the 1929 high. 

And today 92 years after that peak, debts, deficits, and asset bubbles are far greater than at the end of the 1920s.

Below are a number of graphs that all point to the everything bubble.


In the everything bubble, more companies are trading with record P/E ratios than ever. 

So there we have it, incontrovertible proof that this is the mother of all bubbles.

But as we have learnt in this century, bubbles can always grow bigger and especially if we are looking at the end of a major super cycle which could be as big (or long) as 2,000 years.

Nevertheless, the evidence keeps mounting of an epic asset bubble. 

In addition to the charts above that point to illusions never seen before in markets, we have a number of technical indicators that all point to the end of the everything bubble.

In the chart below, the RSI (Relative Strength Index) momentum indicator for example topped in 2017 and the major rise in the Dow since then has not been confirmed by the indicator. 

This is a very bearish sign albeit not a short term indicator.

Many other technical indicators including Elliott wave or Dow Theory all point to that a top to the everything bubble is imminent. 

Whether that means a top next week (which is possible), or in the next few months, time will tell. 

Some important cycle indicators point to potential turns between now and Sep 24.


But what is much more important than pinpointing the exact timing of the top is to understand the risk involved.

If, as we believe, we are now at the end of the everything bubble, nobody needs to time it. 

Investors should understand the upside might be 10% and the downside 90%+.

Who is foolish enough to accept such a risk? 

Maybe a 10% move up but a more certain 90% fall.

We are talking about a fall in real terms. 

If we get hyperinflation stocks and other assets can rise in nominal terms but fall in real terms when measured in stable purchasing power, like gold.

Well, that question is easy to answer. 

The whole investment world which has been spoilt by tens of trillions of dollars of fake money to fuel the Epic Everything Bubble will expect much more of the same in coming months or years.

Yes, much more money will be created but this time it will have very little effect. 

Instead the dollar, euro, yen etc will accelerate the falls that we have seen since 1913. 

They have all fallen 98-99% since then and by similar percentages since 1971 when Nixon closed the gold window.

The final 1-2% fall will soon start and take most currencies to their intrinsic value of ZERO. 

But don’t forget that this final fall is 100% from here.

Remember that measuring your assets in for example dollars is a futile exercise in self indulgence. 

You are just flattering your investment skills when you measure your performance in a currency that has lost 98% since 1971 and 84% since 2000.

If you use the same method in coming years, your paper wealth might look ok but be worthless in real terms. 

Just ask anyone who has lived in a hyperinflationary economy like Yugoslavia, Argentina or Venezuela. 

So what is a Sleeping Beauty investment. 

Not difficult to guess. 

It is an investment that you can forget about for 100 years and when you wake up, it will have maintained its purchasing power.


If we get the expected stock market crash, it is possible that gold and the precious metals continue to correct a bit further like in 2008. 

As opposed to today, gold had then had a major bull run from $250 in 1999 to $1,000 in 2008. 

Weak gold hands then needed to get liquidity against a crashing stock market and the everything bubble.

Gold has now been in consolidation for years and there are a lot fewer speculative  investors compared to 2008. 

Therefore I expect a much smaller and shorter correction, if any.

Coming back to the Sleeping Beauty, there is one investment which you could safely put away and forget about for 100 years. 

It is of course physical gold, safely stored.

As long as you store gold in a safe place and safe country, you know that it will maintain  its REAL value as it has for 5,000 years.  

Yes, there are fluctuations, but gold’s history tells us that it is not just the only money which has survived but also the only money which has maintained real purchasing power. 

 I will continue to show the chart below until that situation is rectified.

This reminds me of the Roman Senator Cato during the Punic Wars (around 150 BC) who finished every speech in the senate with “Furthermore I consider that Carthage must be destroyed”.

In the end Cato got his way as Carthage was destroyed.

I have no doubt that gold will soon rectify the current undervaluation and reach levels that few can imagine. 

This is what both technicals and fundamentals are clearly indicating.

Gold is still a tremendous value. 

Taking the ‘Shame Part’ Out of Female Anatomy

Anatomists have bid farewell to “pudendum,” but other questionable terms remain.

By Rachel E. Gross

Credit...Simone Noronha

Allison Draper loved anatomy class. 

As a first-year medical student at the University of Miami, she found the language clear, precise, functional. 

She could look up the Latin term for almost any body part and get an idea of where it was and what it did. 

The flexor carpi ulnaris, for instance, is a muscle in the forearm that bends the wrist — exactly as its name suggests.

Then one day she looked up the pudendal nerve, which provides sensation to the vagina and vulva, or outer female genitalia. 

The term derived from the Latin verb pudere: to be ashamed. 

The shame nerve, Ms. Draper noted: “I was like, What? Excuse me?”

It grew worse. 

When her teacher handed her a copy of the “Terminologia Anatomica,” the international dictionary of anatomical terms, she learned that the Latin term for the vulva — including the inner and outer labia, the clitoris and the pubic mound — was pudendum. 

Translation: the part to be ashamed of. 

There was no equivalent word for male genitals.

That’s when she really got fired up.

Anatomy as a science had its start in 16th-century Italy, as the purview of learned men. 

At the time it was a stretch to find a female corpse, let alone a female anatomist. 

Little wonder, then, that some words might sound a little off to modern ears. 

What surprised Ms. Draper was that this one had made it through 500 years of revisions and updates — and virtually no one knew what it meant.

That included her anatomy professor, Doug Broadfield, who had been showing the pudendal canal, nerve and artery to students for 14 years. 

“I never really gave it a second thought,” he said. 

“You just don’t really think about that kind of thing.”

Nor was the term limited to academia. 

Anyone who has gone to medical school has probably learned how to perform a pudendal block, a numbing injection at the site of the pudendal nerve. 

It is used to diagnose and treat certain forms of pelvic pain, perform vulval and vaginal surgeries and, though less common than the epidural, alleviate the pain of second-stage labor.

Doug Broadfield of the University of Miami’s Miller School of Medicine, with the “Terminologia Anatomica.”Credit...Gesi Schilling for The New York Times

Dr. Antje Barreveld, a pain management specialist at Newton-Wellesley Hospital in Massachusetts, performs around 250 pudendal blocks a year. 

“It’s incredible that this Latin term has really persisted,” she said. 

“What does that say about the medical establishment and their view of women?”

In 2019, with Dr. Broadfield’s support, Ms. Draper began research for a paper arguing that pudendum was inappropriate as a medical term and should be removed. 

“It was a project of fascination,” she said. “I just had to get to the bottom of it.”

‘Shame,’ narrowed to women

In the beginning, shame knew no sex. 

First-century Roman writers used “pudendum” to mean the genitals of men, women and animals. 

But it was women to whom the shame stuck.

In 1543, the word made an appearance alongside an odd illustration in an anatomical atlas by Andreas Vesalius, a Flemish physician sometimes called the “father of modern anatomy.” 

The image, although labeled a human uterus, looks unmistakably like a penis, but with a tuft of curly pubic hair near the head, reflecting the idea that women were just men with imperfect, internal body parts. (Also, recall the dearth of female corpses.)

A century later, a Dutch anatomist named Regnier de Graaf highlighted the role of the clitoris in female sexuality. 

“If these parts of the pudendum had not been endowed with such an exquisite sensitivity to pleasure,” he wrote, “no woman would be willing to take upon herself the irksome nine-months-long business of gestation, the painful and often fatal process of expelling the fetus, and the worrisome and care-ridden task of raising children.”

In 1895, anatomy officially recognized a pudendal region in both men and women. 

But 60 years later, only the “pudendum femininum” — the female shame part — was still listed. 

It would later be simplified to “pudendum” and used as a slightly more formal synonym for vulva. 

Today, the word appears in almost every medical textbook, including recent editions of “Gray’s Anatomy,” “Williams Obstetrics,” and “Comprehensive Gynecology.”

Ms. Draper wasn’t the only person bothered by these roots. 

In 2014, Bernard Moxham, head of anatomy at Cardiff University in Wales, collaborated with Susan Morgan, from the same university, to examine gender bias in anatomy teaching. 

Most medical textbooks, they found, showed the male body as standard and trotted out the female only when it came time to show the reproductive system, genitals and breasts.

Andreas Vesalius (1514-1564), a Flemish physician often considered “the father of anatomy.”Credit...Classic Image/Alamy

An illustration of female reproductive organs from Andreas Vesalius’s “De Humani Corporis Fabrica” of 1543.Credit...Wellcome Images/Science Source

In 2016, the pair asked hundreds of medical students and anatomists whether they had any concerns about the fact that the word “pudendal” stemmed from “to be ashamed.” 

Most did not. 

One anatomist added that “it’s interesting where it comes from, but it’s established terminology now.”

This blasé attitude appalled Dr. Moxham. 

It wasn’t just the inherent sexism of the term, he said: “There is an element of that, there’s no question about it. 

But it also, I think, is both scientifically and biologically inappropriate.” 

As a general rule, anatomical terms are supposed to be informative and descriptive. “Pudendum” was neither. 

“This is the only term which has a moral context to it,” he said.

There are other terms that reflect antiquated notions about women. 

The word hymen, which persists in nearly all medical textbooks, shares the same root as Hymen, the Greek god of marriage. 

Nymphae, a slightly older term for the labia minora, comes from the Latin word for bride or beautiful young maiden. 

Even the word vagina, which translates into sheath, scabbard or close covering, suggests that this organ’s primary function is to house a penis, which is not accurate or scientifically neutral.

Dr. Moxham knew that even established terms could be changed, and thought they should be, as part of efforts to weed out racial and gender bias in medicine. 

He had just stepped down as president of the International Federation of Associations of Anatomists, which was working to release the newest edition of the “Terminologia Anatomica.”

In 2016, Dr. Moxham proposed that the federation’s terminology group — which was, at the time, all male and mostly European — remove “pudendum” and related words from its upcoming dictionary. 

He couldn’t tackle all of sexism within anatomy, but removing this one troublesome word seemed like an easy task. 

“I couldn’t see any problem at all,” he said. “I just couldn’t have imagined.”

‘That’s just not going to fly’

The terminology group describes its mission as stewarding a vocabulary that is “nimble and adaptive so as to remain relevant in a rapidly evolving world of medicine, biomedicine and health-related professions.” 

But in practice, progress is slow. The guiding rule “is to be conservative when considering changes to terminology and logical in implementing changes,” Thomas Gest, an anatomist at the University of Houston and the former chair of the terminology group, said in an email.

The “pudendum femininum” entry in Ms. Draper’s copy of “Terminologia Anatomica.”Credit...Gesi Schilling for The New York Times

“This is important,” she said about changing terminology, “because women, especially women of color and especially gender-nonconforming women, are not getting the same health care.”Credit...Gesi Schilling for The New York Times

At first, not everyone was convinced that “pudendum” was egregious enough to warrant throwing out. 

Some argued that the Latin root wasn’t just about shame; it could also, in theory, imply virtue or modesty. 

Also, if you were going to change a word based on its weird Latin root, you’d have to start questioning hundreds of terms. 

Why does “penis” mean tail? 

Why does “acetabulum” — the hipbone socket — mean vinegar bowl?

“People do not like change,” Shane Tubbs, an anatomist at Tulane University who leads the terminology group, said. 

“There’s some people in the anatomy world that are really wedded to the history of where the terms come from.”

After some grumbling, however, everyone agreed that “pudendum” had to go. 

Then came time to change the related words: pudendal nerve, pudendal canal and pudendal artery.

To many members of the group, renaming a nerve that doctors referred to on a regular basis was a step too far. 

“There’s no way anatomists can maintain any credibility with surgeons and other biomedical people if we say they can’t use ‘pudendal’ anymore,” Dr. Paul Neumann, a Canadian neuroscientist and member of the terminology group at the time, said. 

“That’s just not going to fly.”

“You can’t just throw out the only name something’s ever been known by,” he added. 

“And that’s where the fighting really got intense.”

For months, heated emails flew over what to do with the offending terms. 

One member ultimately resigned. 

The dispute grew so contentious that, in August of 2019, at Dr. Moxham’s suggestion, the group agreed to a two-year moratorium so that tempers could cool. 

“How heated can a bunch of nerds get?” Dr. Gest asked. 

“But as far as nerds go, that was about as heated as we could get.”

View from the doctor’s office

The decision came quietly. 

Ms. Draper learned about it in late 2019 from a paragraph at the bottom of a medical article: “Pudendum” would no longer appear as an official term in the upcoming version of “Terminologia Anatomica.” 

However, the article noted, the pudendal artery, canal and nerve would remain relatively unchanged “because the use of the word pudendalis in terms for structures present in both sexes cannot be interpreted as sexist.” 

In other words, if the shame was spread equally, maybe it wasn’t so bad.

Not everyone was satisfied. 

Even if clinicians were reluctant to adopt new words, “this is not a reason for perpetuating the use of incorrect/offensive terms,” Beverley Kramer, a South African anatomist and the current president of the anatomical federation, said in an email. Dr. Moxham agreed. 

“There will always be people who will be antediluvian,” he said. 

But “what is the point of having any terminology group unless it’s willing to grasp nettles on occasion?”

Ms. Draper, her original goal accomplished (albeit by others), saw an opportunity to start a larger conversation about gender bias in medicine. 

In her article, published this year in the journal Clinical Anatomy, she argued that the same sexist attitudes that had allowed pudendum to persist in the medical lexicon for centuries had real-life consequences in health care today.

Ms. Draper, who will graduate in 2022.Credit...Gesi Schilling for The New York Times

“This isn’t just people arguing about semantics,” she said. 

“This is important because women, especially women of color and especially gender-nonconforming women, are not getting the same health care or access to health care that they deserve.”

Shame is one factor that contributes to women, transgender men and nonbinary people with vulvas receiving worse or delayed care. 

A 2014 survey by British charity The Eve Appeal found that one-third of young women avoided going to the doctor for gynecological health issues, and 65 percent struggled to say the words vagina or vulva. 

That same year, American public health researchers found that up to half of those with vulva pain never raised their concerns with their doctor, at least partly because of stigma.

Leilani A., 30, never had trouble talking about her sexual anatomy. 

Then, in November 2018, she started feeling a persistent pain between her legs. 

“When I say burning vulva, I mean on fire,” she said. 

Sex was excruciating; doctors suggested she try a glass of wine.

“It feels like the shame nerve,” she said. 

“I had so much shame that I was like, Oh, my god, because I’ve been such an open, sex-positive person, is this my punishment?”

More than a year later, she was diagnosed with pudendal neuralgia, a chronic pain condition in which the pudendal nerve becomes injured, irritated or compressed. 

It occurs in men and women and is more common in athletes who cycle or ride horses, as well as women who have given birth or undergone pelvic surgery.

She eventually found treatment. 

But Dr. Barreveld, the pain specialist, says that many sufferers — particularly men, who make up one-third of her patients with pudendal neuralgia — are either reluctant to seek help or don’t know where to turn. 

To put her patients at ease, she has made a tweak to her own language: She started calling the pudendal nerve “the undercarriage nerve.”

“It’s maybe a little bit more of a gentle way of referring to a very private area,” she said. 

“It makes people chuckle and removes a little bit of that shame response.”

In a practical sense, officially renaming this nerve would pose a challenge for clinicians like Dr. Barreveld, who refer to it every day. 

However, “I think it’s the right move,” she said. “It’s hard to make these changes, but at the same time it’s a really powerful statement.”

Turning the page

In a way, the pudendum debate can be seen as an extension of the movement to remove the names of unsavory “discoverers” from medicine.

In recent years, there have been petitions to rename the instrument commonly known as the Sims vaginal speculum, a tool used by obstetricians and gynecologists to observe the cervix. It was named for James Marion Sims, a Southern gynecologist and slaveholder who made his advancements by experimenting on enslaved women.

“We’re looking closer into the meaning of words,” said Dr. Sabine Hildebrandt, an anatomical educator at Harvard Medical School and author of “The Anatomy of Murder: Ethical Transgressions and Anatomical Science During the Third Reich.” (Dr. Hildebrandt attended medical school in Germany, where the lay word for labia is Schamlippen: the shame lips.)

It is the younger generation — future doctors like Ms. Draper, who will graduate in spring 2022 — who are leading this charge. 

“We’ll have to see where this goes,” Dr. Hildebrandt said. 

“We’re in the middle of a movement here, that’s for sure.”