Delivering Malaria Meds Using Coca Cola Supply Chains?
Coca Cola is walked to points of sale in unreachable areas of Africa
Though the details were hazy at first, over time, I’ve come to understand what my employers are trying to do.
In Africa, health care is a premium. What health care is offered is often difficult to access. When accessible, medicinal supplies are limited, stock outs are common, delivery ineffective and, user fees prevent the poorest of households from obtaining affordable medications.
Coca Cola on the other hand is ubiquitous. I may not be able to buy anti-malarials, get on ARTs or even a decent meal, but I can get a bottle of Coke for an affordable price just about anywhere in all of Sub-Saharan Africa, even in conflict ridden corners of the DRC. Better yet, at least for me, this is the old Coke made from cane sugar, not the new, artificial kind we get in the US.
Some folks (who pay me money to do stuff) ask the obvious question: if the multi-national Coca Cola company can get soft drinks in every corner of the globe, why can’t we effectively deliver badly needed medicines to the same people?
My colleagues then examined the nature of private supply chains that deliver Coca Cola and contrasted them with current methods of pharmaceutical delivery. Private supply chains which deliver things like Coca Cola, beer, soap, shampoo and cel phone cards are incredibly efficient.
Soft drink manufacturers, ship concentrates (to protect intellectual property) into developing countries directly to factories which bottle and prepare stocks for delivery. Stocks are then sent by truck to smaller distributors where trucks are able to pass. Distributors then sell to even smaller distributors who deliver stocks to small shops by vehicle, bicycle, or cattle driven cart, delivering to areas inaccessible due to poor roads, seasonal rains or regional insecurity. Every step of the chain is accountable to the link above it, stocks are paid for on delivery and open competition for delivery routes keeps everybody honest. Empty bottles are then returned along the same supply chain for further bottling, saving resources and keeping costs low.
It’s brilliant, really. It keeps people employed, sales generate cash that goes into communities and insures that small shops are open which can sell other types of consumer goods.
Medicines, on the other hand, are distributed through state run warehousers, which then deliver to district level storage facilities, which then are responsible for delivery to smaller clinics and dispensaries. The trouble is that 1) points of distribution are few and often inaccessible for people in rural areas 2) delivery methods often rely on vehicles which can’t pass through many of the most needy of areas, and 3) deep state control prevents competition amongst distributors and fosters corruption and a lack of accountability.
To encourage this distribution model, policy makers have begun subsidizing ACTs (an effective anti-malarial medication) to bring prices to a level where small corner shops can afford them. They are then sold to local wholesalers, who distribute the meds using the same model as that of Coca Cola, penetrating previously unreachable areas. The model works through low cost and the utilization of informal networks of delivery.
Of course, my politics tell me that bolstering an unregulated private market in essential drugs only undermines the overall quality of public health delivery. Indeed problems do exist and the program is not without its critics, but to deny that the role of private markets is essential to health delivery is short sighted and idealistic. In this case, even given potential problems and implications, the benefits far outweigh the costs.
Sweden: Could it have been a model for Michigan?
Business goes to Sweden because of its amazing metal scene
“Yes, I’ve been there. It has approximately the same population as Sweden, and approximately the same GDP.”
I became instantly depressed as I realized that he was absolutely right. The similarities between Sweden and Michigan are vast. Both are cold areas surrounded by water and both are sufficiently blessed with natural and human resources to support a deep manufacturing sector.
By no coincidence at all, both areas are full of people of Swedish decent.
However, despite having similar social, natural and economic bases, the differences between Sweden and Michigan are immense. In contrast to Michigan, all Swedes have health insurance. In contrast to Michigan, all Swedes have heat. In contrast to Michigan, all Swedes have the right to political representation. Foreigners are even allowed to vote in local elections. In contrast to Michigan, the large majority of Swedes have jobs that allow them to live a healthy middle class existence.
Most importantly, in contrast to Michigan, Sweden has one of the most active, dynamic and vibrant economies on the planet. In fact, riding in from the airport, one sees the headquarters of companies one would expect to see in a place like Michigan, world class manufacturing and tech companies that are all employing Swedes. In fact, Sweden is desperate for labor to support its booming economy. If you have any type of skill, there’s a job in Sweden waiting for you.
Sweden is the most economically equal country on the planet. The Gini coefficient for Sweden in .23 vs. Michigan’s depressing .45, the same as that of Bulgaria or Guyana.
Sweden has some of the highest taxes on the planet. A full half of income can be sent to the Swedish Tax Service. Sales taxes top 25% for most items. Alcohol is taxed at 100%. Taxes make up nearly half of Sweden’s GDP.
It’s a Republican’s nightmare. High taxes, high regulation, high levels of market distorting subsidies on food and public services, heavy rules on public behavior and heavy rules on wages and working conditions. It’s Ron Paul’s worst case scenario.
Despite this, Sweden has one of the most exciting economies on the planet. It is one of the most pro-business places I’ve ever been.
Contrary to Republican logic, this is due, in large part, to guarantees of government provided guarantees of quality health care for all that relieve businesses of having to bear responsibility for creating insurance plans. If the large number of boutique vinyl shops all over Stockholm are any indication, anyone can start a small business in Sweden. In America, one has to do without health insurance to start a business, a risk that only the wealthiest can bear.
In Sweden, like health care, pensions and unemployment insurance are funded through citizen contributions. This means that private businesses don’t run into the problem of becoming bankrupt when they lack money to fund their pension plans.
The Swedes are highly educated and healthy. This means that foreign businesses wanting to set up shop in Sweden have a vast pool of highly educated and able potential workers to draw from. In fact, Sweden’s biggest problem right seems to be that it lacks UNskilled service workers.
All of this is in contrast to the disastrous situation of Michigan, where we have gutted public education to the point where we have one of the highest drop out rates in the country. We get stupider by the day. Nearly 15% of Michiganders lack access to health insurance. Michigan workers are too sick and too uneducated to meaningfully contribute to the economy. Worse yet, the recent installation of emergency financial managers has erased any potential for improvement. Nearly half (note: the poorest half) of Michigan lacks political representation in 2012, clearly a dream come true for Republicans everywhere.
Why would any business come to a place like Michigan?
Mostly, I’ve returned depressed. Michigan had its chance and it blew it. Exactly why do I live here?
An Airport Layover, ITN Wedding Veils, Science Fiction in Africa
I’m so much at a loss as to what to write and this blog has sat rusting for the past couple of weeks. I was hoping some of my friends would pick up the slack, but, alas…
So, while I sit here at the Amsterdam Shiphol Airport drinking incredibly expensive but exquisite European coffee, I will inundate you with news items that have caught my attention recently.
The Malawian judiciary is on strike. Yep, the whole judicial branch as far as I know. Incredible. Imagine if the entire federal court system of the United States decided to take a break? Fortunately, US federal judges and court workers are getting paid, unlike their counterparts in Malawi. The strike is estimated to cost in the hundreds of thousands if not millions of dollars, money Malawi simply cannot afford to lose. Rerorts are coming out that hospital workers are starting to strike, as well.
The Africa Report is late on the game and reports that insecticide treated bed nets that were distributed for free are being used for drying fish and wedding veils. While this is old news for us in the malaria world, the article continues to fan the flames of arguments against giving free stuff to poor people. No mention of whether the nets used for drying fish acutally provide benefits to the economic profile of the community, however. Maybe they are just holding back knowing that I’m working on a paper.
The same Africa Report did manage to write a cool article on African film schools. It’s not surprising that many African countries don’t have developed national cinemas, but a sad state of affairs nonetheless. With funding from European donors, a film school has been created and scholarships offered to more than 100 potential African film makers. The positioning of the school in Nigeria is dubious, however. Nigeria is know for film, but not for the kind that draws international attention. I would love to see a new generation of film makers in the tradition of Senegalese film maker Djibril Diop Mambéty or Abderrahmane Sissako, rather than the cheap throw aways that Nollywood is famous for, but we can’t have everything, can we?
In the mean time, here’s a trailer for the Galway African Film Festival of 2011, which includes clips from Kenya’s Pumzi, what is probably Africa’s only science fiction film (besides South Africa’s District 9).
Malaria Deaths Higher Than Previously Thought: Or Not?
In this week’s Lancet, Christopher Murray published a paper presenting evidence that deaths due to malaria are vastly higher than “official” estimates from the World Health Organization. Specifically, Murray, et al. estimate that worldwide malaria deaths, though declining over time, exceeded 1.24 million compared with the WHO’s estimate of more than 600,000.
Most notably, the Lancet paper speculates that adult deaths from malaria are far higher than previously though, contradicting accepted medical ideas that immunity increases with age, freeing adults from the risk of mortality.
Murray’s paper is not without precedent. In 2010, Dhingra, et al. also called the WHO’s estimates for malaria mortality in India into question, estimating between 125,000 and 277,000 deaths were due to malaria, far exceeding the WHO’s extremely reassuring estimate of 15,000.
That malaria deaths are down worldwide is an uncontroversial notion. The wide discrepancy between published estimates of the worldwide burden of malaria mortality is, however, highly controversial. Overestimating mortality can stream precious monetary donations, most notably from big players such as the Global Fund, needlessly toward malaria, at the expense of other health concerns such as TB and HIV. Underestimating the number of deaths from malaria, can leave countries short changed and unable to fight their own malaria related problems.
Either way, controversy as to the accuracy of reporting dishevels confidence and could provide more fuel to those who advocate for reductions in global aid to fight developing world health problems (read: all of the current Republican candidates) and distract from the creation of efficient policy.
What is needed, of course, is accurate reporting and a reliable flow of health information worldwide. Many developing world governments, however, lack the resources to efficiently provide these numbers. World aid bodies, however, have, to date, missed this essential piece and reporting methods remain antiquated in many areas.
I just visited a facility in Kenya, where records are still kept on paper, and left to mildew in an unused toilet (I kid you not). One could assume that if the records were left in a functioning toilet, the numbers might end up at the bottom of a pit latrine. With the base of the worldwide reporting system in such a shambles, how can we expect accuracy in reporting?
[The Lancet, Volume 379, Issue 9814, Page 385, 4 February 2012 doi:10.1016/S0140-6736(12)60169-X] — (English) This week we publish surprising and, on the face of it, disturbing findings. According to Christopher Murray and colleagues at the Institute for Health Metrics and Evaluation
(IHME) at the University of Washington in Seattle, there were 1·24 million deaths (95% uncertainty interval 0·93—1·69 million) from malaria worldwide in 2010—around twice the figure of 655 000 estimated by WHO for the same year. How should the malaria community
interpret this finding? Before we answer that question, we need to look beneath the surface of this striking overall mortality figure… Global malaria mortality between 1980 and 2010: a systematic analysis [The
Lancet, Volume 379, Issue 9814, Pages 413 - 431, 4 February 2012 doi:10.1016/S0140-6736(12)60034-8] — (English) We systematically collected all available data for malaria mortality for the period 1980—2010, correcting for misclassification bias. We developed a range of predictive
models, including ensemble models, to estimate malaria mortality with uncertainty by age, sex, country, and year. We used key predictors of malaria mortality such as Plasmodium falciparum parasite prevalence, first-line antimalarial drug resistance, and vector
control. We used out-of-sample predictive validity to select the final model…
| WHO Defends Its Numbers On Malaria Deaths [Voice of America (blog)] — (English) The World Health Organization is defending its numbers on global malaria deaths and disputes a new study claiming that nearly twice as many people die of malaria than previously believed…… |
| Malaria death toll disputed [Nature] — (English)
Study doubles official estimate, but scientists say its methods are flawed…… |
| Malaria deaths higher than expected, study finds [Deutsche Welle] — (English)
The latest findings show that the number of malaria-related deaths is nearly twice as high as previously thought. But other experts have doubts about the methods used to produce these estimates…… |
| Malaria deaths hugely underestimated – Lancet study [BBC News] — (English)
Worldwide malaria deaths may be almost twice as high as previously estimated, a study reports…… |
| Malaria kills twice as many as thought: study [Reuters] — (English) Malaria kills more than 1.2 million people worldwide a year, nearly twice as many as previously thought, according to new research published on Friday that questions years of assumptions about the |
| Malaria kills more people worldwide than once thought, study says [Los Angeles Times] — (English) In an alarming statistical turn, the number of malaria deaths every year may be vastly underestimated, according to new research re-examining mortality rates from 1980 to 2010…… |
| Malaria deaths may be double WHO estimates [Financial Times] — (English) Worldwide malaria deaths may be almost twice as high as previously estimated, according to a new study that has sharply divided scientists tackling one of the world’s most deadly diseases…… |
| Malaria death toll possibly twice as high as experts estimated [AP via FOX News] — (English) Malaria may be killing around twice as many people as experts previously thought, and it could also be hitting older children and adults – long considered the least susceptible – a new study suggests…… |
| Malaria death toll possibly twice as high [USA Today] — (English) Malaria may be killing around twice as many people as experts previously thought, and it could also be hitting older children and adults – long considered the least susceptible – a new study suggests…… |
| Malaria Kills Nearly Twice as Many People Than Previously Thought, but Deaths Declining Rapidly [Science Daily] — (English) Malaria caused over 1.2 million deaths worldwide in 2010, twice the number found in the most recent comprehensive study of the disease, according to researchers at IHME and the University of Queensland…… |
| Malaria kills more people, older people [Washington Post ] — (English) A new study found that twice as many people die of malaria every year than was previously thought and that it kills many adults as well as young children…… |
Kenya Post 4: Lake Victoria (plus one)
I don’t have the energy to make a real post tonight, having ridden 7 hours to Lake Victoria, 2 hours of which were on a rickety Kenyan road. Thus, I am posting these three pictures that stood out to me in the hundreds that I’ve already taken. The first two are in the vicinity of Lake Victoria, the last is form a bone jewelry making collective in Kibera, Nairobi.
Kenya Post 3: Trip to Kibera Slum
Kibera
Like slums everywhere, Kibera’s resident flow in from all impoverished areas seeking job opportunities and better lives for their desperate families. Like slums everywhere, Kibera plays an important role in Nairobi’s economy, serving as a source of cheap labor specifically in the manufacture and distribution of hand fabricated goods and migrant agricultural work.
Like slums everywhere, the greater economy depends on keeping the area poor. Public services are sparingly doled out, just enough to keep the residents from rioting, but not so much that the prices of goods coming out of Kibera will rise.
Public sanitation is the greatest challenge in the area. There exists no effective method of handling the large amount of human waste and trash that the area produces. Households will leave waste outside their doorways, where it eventually gets burned or washed away by the rains. One group has created public toilet facilities that composts the waste and uses the methane discharged to allow for cooking by residents. Other public pit latrines are visible in the area, but they are, as yet, too few in numbers to effectively serve the demands of the large numbers of local residents. It is important to note that toilet facilities are not free. If households do not have the money, they will not use them.
Clean water is in plentiful supply, but carefully managed through a system of gouging the public system. The city has run a haphazard series of municipal water pipes through Kibera. Residents either legally or illegally tap into the pipes and then sell the water to other residents. If the tap is legal, the resident must pay a fee to the city. All taps, legal or no, charge for their services. Locals imply that this is merely the market capitalizing on a surrounding demand, but the reality is that the poorest of households cannot afford the water fees. They either illegally procure water from unmanned taps or fetch water from the river which is polluted with human filth. The result of this commercialization of water resources is that poor households have no access to clean drinking water.
Health services are mostly unavailable to resident outside that which is provided by proactive NGOs and private clinics. Though health services are available at low costs from government run clinics, the nearest facility is too far away. I spoke with Elizabeth Akinyi of the “Power Women Group,” a community based organization which supports HIV positive women by selling handmade goods to tourists. She said that anti retrovirals (ARVs) are available from the public clinics, but that the clinics are so far away that even the sickest will not attempt to make the journey. Thus, HIV positive residents depend on the good graces of donor agencies and NGOs to provide medications. Medications, however, are not free so the revenues from the groups store are essential to keeping these women alive and, as they put it, “living positively”.
It should be obvious that the greatest challenge to poor Kenyans is being able to bear the costs of services. As one person told me, “in Kenya, the only thing free is the air.” In addition to water, the city provides power to some parts of Kibera, which also must be paid for. Homemade television antennas can be seen over just about every household. Every once in a while, one can see a satellite dish. Public schools exists, but slots are too few to accommodate all of the children in Kibera, so many go without. Local groups have stepped up to attempt to provide basic education to children but without formal education, the children of Kibera have little future.
All of this, however, should not distract from the incredible resolve of Kiberans to make a better life for themselves. Everyone in Kibera has some kind of business. Street sellers, small fabricators and small businesses are to be seen everywhere. Some follow western models of individual entrepreneurship such as that of the owner of “Apokolipto Cinema” a small DVD theater that runs showing of bootleg horror and action DVDs from morning to night. Many of the larger operations, however, do not. Employee owned fabrication groups produce products for sale in Nairobi, but split profits amongst themselves and provide for school fees of employees’ children such as that of Kibera Jewelry, who make necklaces and other goods from recycled bone products. Kibera tours, the group that allowed me to visit the area, is a mixture. Though owned by one entrepreneur, the success of his tour depends on cooperation with local groups. Profits from his tour group are split between himself and the groups who participate.
It could be said that unemployment is rampant throughout Kibera, but then it could be said that not a day goes by where Kiberans are not doing something to make some money for themselves. A lack of access to capital and dependable city services, however, prevent the area from reaching its true potential.
Kenya Post 2: Arrival
Sunset over Kenya
Even from the sky, Nairobi is doing well. Lights are to be seen everywhere, paved roads are obvious and even from the sky, the condition of the vehicles is vastly superior to anything found in Blantyre, for example. The airport is filled with Kenyan Air planes, newer air terminals and even newer vehicles. Even the terminal bridge features large ads for EPSON printers and not Zain telephone cards. Stepping out of the terminal bridge however, I notice that the tiles on the ground are mismatched and haphazardly linked.
I nearly twist my ankle stepping in. Now this is the Africa I know.
Immediately, I go into travel mode, go through passport control, get bag, exchange money, clear customs, all as quickly as possible to beat the mad rush of people entering who probably don’t know what they’re doing. I secure a taxi driver named Sam. That’s really the first thing you have to do: secure a trustworthy driver. Treat them well and they will treat you well.
He compliments me on my English, though I remark that his English is better than mine. He says “No, no, I used to work in Mombasa.” The US has a base in Mombasa and Sam used to work driving military men around. “The talk so fast, I can’t understand anything they say. And they use foul language.” I inform him that US military recruits often come from the countryside and that they don’t use foul language when their mothers are around. “They should know that they disrespect me. Please tell them.” I agree to.
The talk of the military leads him to give me a run down on the war with Al Shabaab from Somalia. He instructs me not to go to the North. In the States, we fight wars elsewhere. It’s hard to fathom an active conflict just miles away from relative prosperity.
The times have been good to Nairobi. The lights are on. The roads are paved. Cars are in very good condition. The normal burners seen hobbling through Blantyre are not to be seen here. I make note of multitudes of hotels and at least ten neon lit casinos on the way. “The Chinese are here now, ” Sam says.
Indeed he is right. Even billboards are written in Chinese now. It’s clear that Chinese investors are creating a parallel economy, one for the Kenyans, one for western tourists, and yet another for the ever increasing numbers of Chinese investors and laborers that, by appearances, are flooding the country.
He points to a brightly lit hotel and remarks that it used to be the US embassy, you know, the one that was bombed by Al Qaeda in the late 1990’s in the lead up to 9.11. It is now one of the best places to stay in Nairobi.
He mentions witchcraft. One can’t go very long in a conversation in Africa without having the subject brought up at least once. His tells me that even the educated are doing it now. Wives, seeking to reign in sexually wandering husbands, place spells on them to control their activities. I ask him if his wife has placed a spell on him as well. He tells me no, that he treats his wife well, though mentions that one never knows whether one is under the influence of one of these spells. If his wife had bewitched him, he would never know. Any of us could be bewitched, even right now.
I make it to the guest house. One of the gate keepers runs a bomb checking device under the car, with an air of formality. The driver laughs and says exactly what I’m thinking, “this kid probably doesn’t even know what he’s looking for.”
The guest house is run by Seventh Day Adventists. They only serve vegetarian food, which is fine with me, though I note to my horror that caffeinated beverages are not allowed.
It is too late to get food at the guest house so I have Sam drive me to get something to eat. He drops me off at an Italian restaurant in the city center. I am convinced that the best Italian food outside of Italy is in Africa.
Leaving the restaurant, I bolt for the cab. Around 20 street women carrying babies surround me demanding money. I guess this is probably their best way of making a living. The wait outside the Italian restaurant for whiteys to leave, then gang up on them hoping that some money might get thrown their way. Interestingly, they are all dressed exactly the same, as if there is a street mother uniform. I barely make it to the car as the driver panics, “Get in the car!” As the door closes, the mothers’ demeanor changes to the familiar laughing and smiling that Africans are known for. They wave us out. I notice the zipper to my bag is open, though nothing is missing.
We drive through the city center. At this time of night, the only places open are nightclubs and a few casinos. We proceed through a gauntlet of prostitutes on the left and drug dealers on the right. I assume the prostitutes are on the left to facilitate entry into vehicles. The drug dealers can sell directly to drivers on the right.
I wonder to myself if the army of baby carrying women over by the Italian restaurant were originally stationed over here with the prostitutes.
The driver reminds me that this is nothing. He says he’ll bring me through on a Friday night. The streets are packed, he says. On morality and consumerism, Kenya is a far different ballgame from peaceful and content Malawi.
Kenya Post 1: The Most Expensive Soccer Ball Delivery Service on Earth
I’m on my way to Kenya, I’ve only made it to the Amsterdam airport. I’m already surrounded by missionaries on their way to Kenya. It seems that the last hold out for Jesus is on the African continent. I talked to one of them and found out that this particular group visits every year. Activities include:
Printing matching Jesus T-shirts
Taking soccer balls to schools
Buying uniforms for kids
Prayer in the slums
Prayer in the villages
Even more prayer in the prisons.
“We can show the kids what it’s like. Makes them realize how glad they are not to be poor.” Honestly, I didn’t know what to say, but I thought, while I looked at this portly gentleman from Tennessee, “I’m glad I’m not you”.
If prayer had an exchange rate, Africa might be the richest place on earth. Unfortunately, prayer does NOT have an exchange rate which leads me to ask what use these people really are.
Think about it. I estimate there are 50 people in this particular group. Each of them will probably cost approximately $3500 for the flights, accommodations, food and transport. That’s a grand total of $175,000. If there is a group on this particular flight once a week, then that’s $9,100,000 spent yearly carting Jesus to Kenya. I’m positive, however, that there are more missionaries fiying to Kenya every year, and positive that there are more missionaries flying to any of the 53 other African countries.
This total money spent on these groups must total in the hundreds of millions of dollars each and every year. It is the most expensive soccer ball delivery service on the planet.
Guest Post: Squatters in the Election Year
I am going to be travelling for the next few weeks. To make up for an anticipated lack of posts, I have enlisted some of my friends to produce content for this site. I took a cue from my friend, Mark, who also pawned his blog off on his own unsuspecting friends.
This post is by one of my best friends, Jeff Harris, who lives in Asheville, NC. I knew Jeff from Mississippi. When he’s not eating squirrels, he studies soil.
My house is in town, but it’s surrounded by thick woods, and sits at the end of a long driveway that winds back behind a huge 100-year old two-story house that’s been vacant for the past five or six years, effectively cutting us off from the view of all neighbors and the street. If I were into horror flicks, I would probably live in terror that a gang of axe-wielding psychopaths might be closing in on our little cul-de-sac at any moment, free to perpetrate their carnage in privacy. I don’t care much for that genre of entertainment, and I don’t harbor that sort of fear (at least not consciously), but I am extremely interested in any human activity I see around the premises of the vacant house that cuts us off from the rest of the world, as you might imagine.
About a month ago, I discovered a squatter living on the back porch of the old house. He turned out to be a harmless but extremely misguided young man who sincerely wants to be healthy and productive, but who has absurd notions about how to achieve that state. He’s an awful lot like I was at his age, but with fewer resources than I had. I’ll call him Kevin. The day I discovered Kevin, I talked to him a lot about his hopes and plans, and he told me about his anxiety disorder and how he was trying to cope with that, and also that he hoped to have enough money from SSI to pay rent somewhere by February. He genuinely seemed to just want to keep his head down and have a hidden place to crash near the gym down the street where he has a membership, and where he works out and showers.
After having tried unsuccessfully to convince Kevin that the rotting, mold-infested house he was squatting in was bad for him both physically and spiritually (it’s a pretty depressing place inside), I decided to leave him to his own devices, at least for a while, hoping he would work things out. He was convinced that being near the gym was better for him than say, staying at the local Occupy encampment five miles away (and he may be right about that) so he stayed in the rotting old house, to my disappointment. A week or two later though, I was happy to see that he had at least cleaned up some debris from the yard, which had been dumped out of an old refrigerator by vandals who had stolen the appliances from the house a year or two ago. It was a tiny indication that he wasn’t spiraling down into terminal homelessness due to depression and nihilism, and so I decided to continue ignoring his presence for the time being, and wishing him the best.
Yesterday, as I rounded the bend in my driveway where the old house sits, I was alarmed to see a guy in in camouflage hunting gear and a machinegun-like device poking around the house. He turned out to be a guy with a metal detector, who said he had been given permission by the real estate agent who’s handling the vacant house. He confirmed her name and convinced me he had actually talked to her, so I wished him luck and went on my way.
Today, the same guy was there again, this time with his young son who was also decked out in serious camouflage and sporting a toy rifle. This time, the guy stopped me as I drove by and alerted me that he had “chased a bum away from the house,” and showed me an old silver quarter he had just found. I told him what I knew about “the bum,” and assured him that Kevin was harmless. He didn’t seem convinced, but when I explained that Kevin had some psychological issues, he looked relived, as if we had finally gotten back on the same page. “Yeah,” he said,” he seemed pretty unfriendly when I ran him off.” I wondered what kind of demeanor he usually expected of “bums” when they were being “run off,” but I couldn’t blame him for his actions – he had done what pretty much any normal person from a private-ownership based culture like ours would have done in that situation. To him, “the bum” was not another human so much as a dangerous intruder, and most likely one that deserved whatever dire situation he happened to be in.
As I was talking to the guy, I looked up and saw Kevin walking back up the driveway toward the old house, in seeming defiance of the guy who had chased him away earlier. Kevin kept his head down and tried not to look our way, just wanting to go about his meager day without any trouble from anyone. But when I called to him and asked him how he was doing, he brightened, looking happier than I had ever seen him, and said he thought he had found a place to live. Unfortunately, since buses weren’t running due to it being a holiday, he was worried that the walk to procure it would take him all day, and he wouldn’t have time to take a shower and would miss the soup kitchen, so he had decided to go tomorrow. I asked him if he thought it would still be available tomorrow, and he said he hoped so, but his face betrayed a tiny bit of doubt. Meanwhile, metal detector guy was following us with extreme interest, looking almost comically surprised at the easy candor I had with Kevin. When I then offered to give Kevin a ride to check out the prospective new housing situation so that he wouldn’t miss the opportunity, metal detector guy’s surprise turned to amazement, and then almost as quickly, into what I can only describe as some kind of peaceful understanding. Kevin had ceased to be a threat, and had become a legitimate human being, just like that. I told Kevin I had to run back down to my house to drop some groceries off, and I’d be back in a few minutes. When I got back, he and metal detector guy were talking, both smiling, and metal detector guy waved goodbye to him as he walked to my car. Belligerence and mistrust had just turned to goodwill, and it had turned so easily.
I tell this story not to call attention to the notion that I did something nice for someone, and that the kindness perhaps even rubbed off a little on someone who was perhaps less inclined to consider the needs of someone less fortunate, but to illustrate that everyone – no matter where they may fall on the cultural spectrum – has the capacity for acceptance at the very least, if not full compassion, for other human beings. The transition of perspective from viewing others as enemies to viewing them as fellow human beings may seem an impossible stretch for some people, especially those who have been subsumed by the worst messages our culture has to offer, but the capacity is there.
This is important to remember as we face the prospect of another election year, which in all likelihood will prove to be an exceptionally ugly one. We will all encounter people who have misguided opinions about what will “fix” the country, and people with pent up rage which they direct toward people of other creeds, cultures and skin color. But it’s crucial to remember that none of these people have the intent to be evil. They are generally just deeply frightened of the uncertainty of life, and are often not bright enough to see how ugly their convictions are (I don’t mean to imply that metal detector guy was prejudiced in this way, but he was almost certainly a part of the particular culture that breeds such convictions). These people deserve compassion too. Their hate is just an instinctual response to fear. And many are greedy and selfish beyond comprehension – but in most cases that greed is really just fearful desperation. When dealing with people who are under the control of such fear, even the smallest gestures of goodwill are incremental nudges toward the diffusion of the fear and hate which fuels their actions. With now over 7 billion people on the planet and a populace deeply divided along certain cultural lines in what has been the most influential country on the planet for the past 100 years or so (we’re all united in our rampant consumerism – some just have more guilt about it than others), we’re sitting on a bomb. De-fusing it will require every bit of courage and delicate, precise action that we can muster. It is crucial that we redirect our disgust away from people we disagree with, and channel it toward their actions, and toward the misguided cultural institutions which reinforce the fear and hate that afflicts them. We must never lose sight of the fact that we are all just frightened mammals – some less frightened than others, and some from a better informed perspective, yes, but equally as capable of causing more strife in the world, if we should forget to view ourselves and others in this light.
Burn My Passport: Citizenship in the 21st Century
My US passport sits on my desk, along with two other ratted and expired versions of it. I often think of citizenship. Mostly, I think of how absolutely meaningless it is and about the ridiculous restrictions imposed by it.
For example, my passport is blue and has the seal of the United States of America on it. With this document, I can enter most countries around the world visa-free and return to the US at will for as long as I hold this document. Malawians, though, cannot travel to most countries without securing travel visas ahead of time, often at great expense. Passports not only restrict entry, they also restrict exit. Even Americans without passports are denied the right to exit the country legally. Malawians, even if they can afford the expense of having a passport, have to apply for special permission to leave.
It is my opinion that, by marriage, I should be entitled to a red passport for Japan as well. I am, to some extent, as personally invested in that country as the United States, equally concerned with the welfare of the population of the archipelago, speak the language and could see myself easily living there again at some point.
Yet, Japan and the US live in antiquated worlds where holding both passports is (on paper) an impossibility. Both countries maintain draconian monopolies on the state allegiance of their passport holders, forcing naturalized immigrants to forfeit citizenship to the country of their birth. Worse yet, the United States forces us to pay taxes to to her, even when we don’t live here and, ostensibly, receive no state benefits.
The Economist recently wrote on the issue of citizenship, stating succinctly:
Citizenship mattered in the days when defence relied on conscription. But modern warfare does not require armies of ill-trained conscripts. Few countries now rely on mandatory military service and those that do are mostly winding down the draft. Citizenship is no guarantee of loyalty: history’s worst traitors have been true-born citizens. Many of those ready to fight most enthusiastically for a flag will have gone through hell to get to their country.
Citizenship is a human rights issue. The implications of citizenship are directly addressed in the Universal Declaration of Human Rights, in Articles 2 and 13. In the United States, though, citizenship is used as a tool to marginalize an entire labor force, deny public services, insure less than optimal wages and allow employers to skirt basic workplace safety and compensation rules. It is interesting that the most fervent proponents of this antiquated system of resident registration, are the loudest advocates against “big government” and for “free markets.” Note Presidential candidate Ron Paul’s narrow and restrictive views of citizenship, which include denying citizenship to people whose only crime was to be born on US soil to parents who fought tooth and nail to get here. It is as if the market can only be free if its participants are determined and protected by the heavily funded and armed hand of the state.
Even worse, the United States is the greatest exporter of advanced degrees in world. We don’t allow Chinese graduate students, for example, to stay in the US upon graduation, despite the fact that the number of domestic PhD’s in the sciences is embarrassingly low. We bring them in, then kick them out as quickly as possible unless they are able to quickly find a private sponsor. God forbid that they might want to start their own operation in the US or work for some small business. So much for promoting entrepreneurship among the educated.
Obviously, some are able to skate this requirement of unipolar citizenship. Canadians and Israelis often hold passports from both countries. People from developing countries, and those who likely have sacrificed the most to attain US citizenship are barred from holding passports in their countries of birth. It is an incredible double standard. Ironically, Israel, which demands the right of dual citizenship with the United States, deny even full Israeli citizenship to the Palestinians.
In an increasingly intertwined and mobile global economy, the concept of the state and of citizenship/allegiance are quickly becoming an antiquated and outdated concept. More than 200 million people around the world live outside the countries of their birth. For me, travelling to another country is the same as travelling to, say, California, taking at least as much time and effort. I am equally employable or unemployable in Japan as I am in the United States. My services are valued as much in Europe and they would be in Africa or South East Asia, so when, I ask, are states going to finally recognize this reality and catch up? Even Reale in 1931, referred to the passport as “an anachronism in the modern world” and predicted that one day, it would become irrelevant.
My recommendations:
1. Abolish passports – Publicly, states will imply that passports are meant to protect and secure borders to prevent incursion by those who pose a threat to the state. Clearly, this did not work on 9/11, nor does it work well anywhere else. The greatest threats to the security of any state probably already possess citizenship. Passports are useless guarantees of the stability of the state and merely serve to exclude economic undesirables. Best to rid ourselves of them entirely.
2. In the absence of abolishment, allow free and open passage worldwide - Proponents of citizenship posit that the “flood gates” will open, and developed states will face an unprecedented flow of immigrants from developed countries. The truth is, that those who wish to come to places like the United States, already do. In addition, most people would rather remain in their communities than travel to places where they know no one. The United States (and Europe) has a system of open borders, but people still choose to live in impoverished hell holes like Mississippi. Many other forces, besides passports, keep people at home.
Clearly, though, the first option is the most radical and the most difficult to implement. The abolishment of passports would mean the abolishment of that which defines the state. Simply, states, as we know them would cease to exist and would become, rather, provincial areas with open borders, but local laws and local systems of taxation. That is exactly what the United States is, though a passport-less world would lack the greater power of a centralized government, such as that of the US Federal Government.
The second option is the most reasonable and should be the goal of states in the 21st century. Without the free and unrestricted passage of all global citizens, the world will stagnate in a restricted and deprived global marketplace, much akin to the restrictive feudal states of pre-Enlightenment Europe. The second option is the best option for the development of global human rights, the free exchange of ideas and economic development. The rising BRIC economies will mean greater economic equality for all world citizens. The United States and Europe need not fear a mass influx of poor people seeking opportunities. They have more than a few options now.
