Freewheel Burning

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).

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?

New estimates of malaria deaths: concern and opportunity
[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 mosquito-borne disease……

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……

 

 

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.

Kibera is one of the biggest slums on earth. Out of 5 million people in Nairobi, up to 1 million (the number depends on who you ask) live in Kibera making it larger than even supposedly big American cities such as Detroit, MI.

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.

A grueling flight, though the planes were largely empty, leaving lots of space to spread out. I was even able to sleep lying down.

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.

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.

For all the nay-saying and mud that gets slung at Africa’s troubles, it’s economic indicators signal nothing but a positive future. Economic growth per capita has been rising consistently throughout the past decade, the financial crisis of 2008 and teh more current European economic crisis barely registering a blip on overall trends of growth. The picture is fasinating. I have included China as a reference. Gabon, Botswana, Namibia, South Africa and formerly war torn Angola all have outpaced China’s much lauded growth. In fact, Gabon’s per capita GDP for 2010 was more than double that of China’s.

Fertility has been declining overall for African countries since the 1960′s. Fertility rates are lowest for Africa’s strong performers, such as South Africa and Namibia. Countries which lack commodity exports and rely on agricultural exports continue to experience not only continued low GDP per capita, but also serve as the source of Africa’s population growth. Realistically, as African economies expand, we would expect fertility to drop even more. Regionally, the African continent is one of the few sources of real human population growth on the planet. Europe, the United States and Canada, China and Japan are all experiencing population stagnation or declines.

Despite a growing population, the number of people living with HIV has either plateaued or declined in nearly all African countries, though given the bottom heavy nature of African populations, we could conceivably see a rise again within the next decade.. Malaria is on the decline everywhere though reductions in the amount of foreign health aid, most notably in the Global Fund could undermine efforts to control it. Life expectancy is up just about everywhere, and infant mortality is down. Africans are having fewer children and seeing more of them survive to live longer and healthier lives.

Challenges still exist, however. Africa is home to unrivaled inequality as economies depend on narrow commodity exports for revenue, rather than bolstering manufacturing sectors which create jobs. Declines in funding for health initiatives could signal a collapse of health care and intervention programs in many African countries which do not budget for health delivery. Poor education infrastructure could further undermine efforts to create viable manufacturing sectors due to a lack of skilled labor. Wild cards like Sudan and the Democratic Republic of Congo could see rapidly return to the bad old days of resource fueled African conflict. The recent election rows in the Ivory Coast and the DRC show that at least some African countries aren’t out of the woods yet. Recent upsets in South Africa and an increasingly autocratic government do, indeed, give one pause to consider a political future for Africa’s strongest economy.

The future looks bright, however, and Africa could follow east Asia’s economic miracle to finally earn its place in the world economy. For the present, however, traditional images of a dying continent and an ineffectual population are slowly being proven wrong.

In “Viva Riva” Congolese director Djo Munga presents a gritty tale of stolen gasoline, African international organized crime and a society in chaos. Riva is a petty criminal who has appropriated a truckload of gasoline from an Angolan crime group. The DRC, like most African countries, is in the midst of a fuel crisis, not having enough foreign exchange with which to buy fuel, poor transportation infrastructure with which to ship it, and a corrupt political system which fails to address the underlying problems which contribute to both. Consequently, gasoline brought in on the black market can fetch more than $10 a liter and fuels (no pun intended) a deep culture of criminal activity.

Munga follows Riva as he gavalants through Kinshasa, visiting the deepest slums, crumbling mansions occupied by Congolese crime lords, families ravaged by the male pursuit of money and status, corrupt but well meaning government officers straddling a knife’s blade of professional and family obligations, desperate women who sell their bodies for survival, the shifting priorities of morality and money and the ubiquitous violence which plagues this vast country.

Viva Riva is an honest though stylistic portrait of a troubled country, shot, unfortunately, not with cell phones (as in his previous “Congo in Four Acts“) but with expensive digicam equipment. The big budget (by African standards) production values unfortunately work against this film’s gritty message, giving it a look that is more appropriate for straight to DVD exploitation features. Despite this, it is clear that Munga seeks to make a political statement while creating a piece that will satisfy viewers looking for gobs of sex and violent action. The most effectively shot scenes of the movie are the candid documentary style depictions of long lines of cars waiting for fuel and shots from cars while driving through Kinshasa at night. The actors in the foreground, unfortunately, take away from this reality.

I’m short on time recently, so, rather than not post at all, I’ll revive my long neglected “Movie of the Week” feature (that died due to being widely ignored) and present one of my now favorite movies. “Touki Bouki” is a avant garde production from Senegalese director and writer Djibril Diop Mambéty. Made for less than $30,000 in 1973, Mambety tells the story of Mory and Anta, a pair of lovers seeking to escape Senegal for a romanticised France.

The film is less of a story, and more of a surreal patchwork of pictures of life in Senegal and insight into the complicated hopes and dreams of a colonized people. France represents a mythical place of prosperity and freedom, though life in Senegal is portrayed as frighteningly real. Mory is a petty criminal who rides around his hometown on a motorcycle decorated with the horns of a bull, and it universally hated and respected by everyone around him. He attempts to get the money to leave Senegal by robbing a gay politician, buys some clothes, steals his car and wins the admiration of the community by throwing money around.

Despite having little experience with film, Mambety’s cinematography is strikingly vivid, a collection of seemingly disconnected scenes shot in full vibrant color, possibly representing the confused and disjointed nature of Senegalese identity post colonialism.

I’m a great fan of African cinema, and this has to be among the best.

The South African Parliament has approved the passage of the “Protection of State Information Bill,” which detractors have called the “South African Secrecy Law.” Its proponents and the ANC maintain that the law is necessary to prevent government employees from leaking important state secrets. Critics view the law as an egregious affront to a free press because it could be hand whistle blowers a draconian sentence of 25 years in prison.

South African human rights leaders such as Bishop Desmond Tutu have vocally come out against the passage of the law, calling it a violation of freedom and a threat to democracy. Amnesty International’s office in South Africa has called the passage of the law a “dark day for freedom.” Business leaders have even criticized the law, stating that it is likely bad for business.

South African newspapers have already reacted with outrage. The Mail and Guardian newspaper printed an edition last week where most of the articles were blackened out in a manner similar to that under apartheid. Journalists and press freedom supporters all over South Africa have taken to the streets to protest the law.

The greatest controversy is not over the move to protect state secrets, but the lack of a public interest provision which would protect journalists and citizens from publicly revealing cases of government corruption. A whistle blower expose’ of a corrupt weapons deal, where defense contract Thyssen-Krupp made improper ANC donations to secure the sale of several large naval carriers, would be a punishable offense under the new law.

Attempts to curtail a free press to protect the shady dealings of politicians is not a new phenomenon, of course. The rise of such heavy handed policy in post-apartheid South Africa, which can proudly boast of one of the most progressive constitutions on the planet, is not only sad, but also troubling. Politicians and the powerful state elite in other Sub-Saharan countries will no doubt be emboldened by the effort.

Last year, Bingu wa Mutharika and the DPP, the president and ruling party of Malawi, introduced and passed a a consitutional amendment sharply curtailing press freedom. Section 46 of the Penal Code now states: “If the minister has reasonable grounds to believe that the publication or importation of any publication would be contrary to the public interest, he may, by order published in the ‘Gazette’, prohibit the publication or importation of such publication.”

They have since routinely harassed newspaper unsympathetic to the increasingly autocratic Mutharika and had journalists arrested and beaten. DPP supporters have detained academics who speak out against the failing Malawian government. In the most recent riots this past June, DPP thugs were there not only to incite violence, but to intimidate those opposed to the present government, by brandishing machetes and beating demonstrators.