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Needless Drug Shortages Threaten the Lives of TB Patients
Several drugs to treat Tuberculosis have made it to the FDA’s drug shortage list. (I recommend a quick glance at the list. Big government (thankfully) at work!)
A friend/acquaintance of mine posted that the following medications are presently in short supply, or unavailable: Isoniazid, Rifampin, Ethambutol, Amikacin, Streptomycin, Tubersol and Aplisol.
Now, I’m not going to pretend to be an expert on TB, though I do know enough about the condition to know that TB is most common among the poorest and most marginalized members of society. In Malawi, I’ve seen active and advanced cases of TB. It’s an awful sight.
People who live in substandard housing in urban areas, prisoners, alcoholics and homeless people are at particular risk for infection. It’s particularly common in Africa, and a problem that seem to be getting worse, rather than better. Coinfections with HIV are common.
Japan, specifically the Airin area of Osaka, where homeless men and day laborers congregate in substandard and densely occupied housing units, is well known to have one of the highest incidence rates of TB in the developed world. Russian prisons are also famous for TB transmission, as the work of Paul Farmer has shown.
According to the FDA list, many of the drugs are in short supply due to “Demand increase for the drug.” I find the claim to be somewhat dubious. Drug companies have long been known to be sleeping at the wheel when it comes to development of new drugs for TB. Most of the drugs that are currently used were developed in the early the mid 20th century, with one very recent exception (Bedaquiline).
I find it highly unlikely that demand for the drugs went by unnoticed to drug companies. I suspect that there simply isn’t enough profit in the drugs to warrant ramping up manufacturing.
The implications are, of course, immense. If drugs to treat TB are unavailable, opportunities to transmit TB will persist. Given the nature of the populations which are at risk for the disease, we can expect a resurgence in cases. Worse yet, the longer a patient has the disease, the more likely it is that the infection will become resistant to all medications, making treatment nearly impossible.
Food Prices and Conflict in Sub-Saharan Africa
African Conflict and Worldwide Food Prices, 1997-2013
I’ve written before on the link between unrest in South Africa and the problem of rising food prices. Looking at the plot of the right, it’s not hard to notice the similarities in the series of conflict events post 2005 to food prices as estimated by the FAO’s Food Price Index (FPI).
I began to wonder whether some of the recent rise in conflict events is somehow related to rising food commodity prices. Having found a correlation in South Africa, it’s not out of the realm of possibility.
I calculated the cross correlations between the FPI and conflict events and found that the FPI was predictive of conflict, but that conflict was not predictive of FPI. This was similar to what I found in South Africa.
Plotting the FPI against the number of monthly conflict events, I found something interesting. It appears that the two are mostly unrelated until the FPI reaches a threshold of approximately 200, then the number of monthly events shoots up. It is interesting to note that in other research, 210 was the assumed maximum price that households would absorb before taking to the streets.
I’ve repeatedly written on the problem of stock market speculation in food commodities as a cause for rising volatility in world food prices. I won’t beat this into the ground again. However, results such as these indicate that the problem of rising and volatile food prices is not just an economic problem, but also a problem of human health and welfare.
FPI and Monthly Events with Threshold
Cross correlations of FPI and monthly conflict events
Conflict in Africa Getting Worse: A Good Sign?
Conflict events in Africa, 2012
I started my newfound state of semi-freedom by reading, something I haven’t done in while (outside of papers on malaria). Mo Ibrahim, cel phone magnate and philanthropist was interviewed by the World Policy Journal in the most recent issue.
Mo is responsible for bringing cell phone technology to Sub-Saharan Africa, expanding telecommunications on the continent from a few thousand land lines (outside of North Africa and the country of South Africa) to more than 500 million mobile subscribers today.
The total number of phones in Africa was maybe two or three million fixed-line phones. And this was mainly in South Africa in the south or in Egypt, Tunisia, and Morocco in the north, and nothing in between. Right now, Africa has more than 550 million mobile subscribers. This is more than the number of mobile phones in Europe, by the way. This brought farmers to the market place. It brought new services. Banking now in Africa is done more with mobiles than in actual physical branches of banks. All kinds of services are available cheap like mobile banking services, which are more used there than in Europe or the United States. It improved elections and democracies. The democratic process improved a lot because of the transparency. It encouraged entrepreneurship and economic growth. So a lot of things happened, especially in a place like Africa, which badly needed that kind of service which bridged so many years of underdevelopment, and that is wonderful. With information at their fingertips, people are able to communicate, able to talk to each other. This should bring a better sense of understanding and less conflict.
It was the last sentence that intrigued me. Could the expansion of cell phone coverage in SSA be associated with a decline in conflict? Armed with my statistical tools, I was ready to check test this hypothesis.
Unfortunately, I was unable to find much data on cel phone coverage. It appears that providers are either reluctant to publicize it, or are too fractured to merit a single source of data.
Data on conflict events, however, are reliably stored at the Armed Conflict Location and Event Database (ACLED). I have written on the database before, but hadn’t looked at it since late 2010.
What I found was disturbing. Conflict events have not decreased in SSA. In fact, there are more than ever. in 2012, there were more than 10,000 events recorded, almost double the number of events in 2011. Many of these events were protests (3,292) but there was a disturbing number of events involving state violence against civilians (2,706).
These events are spread throughout the continent, but far too many are occurring in developed hot spots like South Africa and Kenya (as the map shows).
Now, this could be a result of increased recording of events in the database. it could also be a result of the expansion of cell phone technology and the free exchange of information on the continent.
It is clear, though, that wider access to mobile technologies is not leading to peace on the continent, but rather more violence. However, protest is a hallmark of democracy and development. Let’s hope that these protests, as bloody as they may be, lead to wider access to public liberties and stable governance.
Perhaps this is a sign of good things to come? It’s certainly up to debate.
African Metal
Botswanan metalhead
So I went looking for some. Here’s what I found.
Botswana: What Bogota, Colombia is to South American punk and metal, Botswana is to African metal. You can tell by this series of pictures of true Botswanan metal heads. Amazing. Overthrust, Skinflint, Wrust and Crackdust keep the scene going.
Vice did a spot on them and Giuseppe Sbrana, lead guitarist and vocalist with the band Skinflint had this to say about their amazing fashion:
the scene’s dress code is ‘old school.’ “A good example of where we get the style from is Motorhead’s Ace Of Spades cover,” he says. “Also many metalheads in Botswana are cowboys from the villages and farms, so they mix the cowboy image with a biker metal look. Many wear hunting knives and parts of dead animals. We drink from the hollowed-out horns of cows.”
Angola: Somebody went to the trouble of making a documentary on not just Angolan metal, but Angolan death metal. Already accustomed to some of the most aggressive dance music on the continent, having been in a civil war for decades, and now rising quickly to be an economic powerhouse, Angola is a perfect breeding ground for metal.
Zambia: Zambia has a deep rock history that I was completely unaware of. Amanaz from 1975 had some killer heavy psych jams.
Cameroonian metal experiment
Mozambique: I’ve heard stories of a metal scene in Maputo. Not surprising since Mozambique likely communicates with sister Portuguese colonies Angola and Brasil. A documentary exists.
Kenya: I knew it had to be true. There is metal in Kenya. Where there is plenty of electricity there will be metal.
Tanzania: This one’s a little bit dubious, but alledgedly there’s a one man black metal act called Giza Uchawi, who released a cassette “Kivuu” back in 2002. Could be a hoax, but who knows?
Uganda: Uganda is the big mystery. Despite a multitude of problems (the LRA, the kill the gays bill), the have gay pride marches and now Veil of Amonition, who count Goatwhore as a an influence.
OK, back to work.
Distracted by Dissertating, Hotels in Tunduma, and Distractions from Distractions
Taken near Tunduma. Trucks carrying goods to and from the DRC.
I had a few minutes today to read the new Economist, which turned into more than a few minutes when I noticed an excellent feature on Africa’s economic rise. These features are not rare for the Economist, however. Reporting on Africa in that “newspaper” (as they refer to the themselves) is generally quite good. Perhaps it has something to do with being a magazine published in a former colonial power.
The Economist doesn’t make the names of the reporters easily known. The journalist in question, however, embarked on a whirlwind tour of the best of Africa, starting in South Africa, worming his way up through Zimbabwe, Zambia, Tanzania, Kenya, Ethiopia, over North Africa, then down through Ghana and West Africa.
As a testament to Africa’s development, he notes:
The journey covered some 15,800 miles (25,400km) on rivers, railways and roads, almost all of them paved and open for business. Not once was your correspondent asked for a bribe along the way, though a few drivers may have given small gratuities to policemen. The trip took 112 days, and on all but nine of them e-mail by smartphone was available. It was rarely dangerous or difficult. Borders were easily crossed and visas could be had for a few dollars on the spot or within a day in the nearest capital. By contrast, in 2001, when Paul Theroux researched his epic travel book, “Dark Star Safari: Overland from Cairo to Cape Town”, he was shot at, forced into detours and subjected to endless discomforts.
Which is totally in line with my own experiences, though he downplays the hazards of highway travel presented by the numerous poorly conditioned fourth hand vehicles all over the roads (road accidents may be killing more people than HIV in 2013). We can forgive at least that, I guess.
Of interest was this, however:
On a journey of nearly 600 miles across the country from Dar es Salaam, the commercial capital, to the Zambian border, the phone signal never falters, and every town has mobile broadband internet. Had there been a hotel in Tunduma, the border village, it could have been booked online. But the only place available is a sticky room with a broken television, welded into a metal case to thwart thieves.
I’ve done that drive, and been to Tunduma. If he would have bothered to write, I could have recommended a wonderful hotel nearby (complete with surreal cement safari sculptures) that certainly can be booked on line. The TV’s work and even have CNN and Bloomberg News.
Sensationalist Reporting on the Kenyan Election
NYT headline, Feb 22, 2013
There’s no doubt that the events in the article occurred and is worthy of reporting. The NYT, however, has been near silent on the subject of the Kenyan elections, arguably the most important political event in the world in early 2013. After months of nothing, we get a picture of a near decapitated infant.
The 2008 Kenyan elections were an absolute disaster. Such a disaster, in fact, that the entire country is proactively wishing that the next one (scheduled in March) passes peacefully and without incident. I am, of course, skeptical that the elections will proceed entirely without incident as Kenyans universally insist, but I think it unlikely that there will be near the extent of bloodshed.
ICC court proceedings are constantly broadcast live in every eating establishment and bar in the country, likely as a grim reminder as to how bad things can be, but also as a deterrent to further violence. The festering remains of IDP camps on the sides of Kenyan highways are even more grim, particularly when one realizes that a few people are still living in them.
As the article says, Kenya is an oasis of development in a highly troubled region (it borders Somalia). In 2013, Nairobi is no different than Houston, TX. I’m not a fan of either, but it’s telling when I can go into a Nairobi supermarket and be offered free, processed food samples, just as I would at Meijer back home. It’s telling when I can buy real coffee (not instant) at a local Starbucks analogue. Granted, the rest of the country has a lot of catching up to do, but there is light at the end of the tunnel.
A Visit to the Local Witch Doctor
The Healer holding a diarrhea medication and wearing a medicinal herb which alleviates joint pain.
My friend, Gabriel, though, knowing I’m into weirdness, took me to one tonight. By sheer coincidence, we happened to run into him on the way walking with a young gentleman. After a brief exchange, he was kind enough to agree to see us and led us back to his house.
Through Gabriel (my Luo is beyond poor), I asked him what the young man was doing there. The healer told me that someone had stolen some items from the guy. He had come to the healer to ask him to use his magic to reveal the identity of the thief and purchase some medicine with with to curse the man who had stolen his property. I asked him if people came to him often with such troubles. He replied that yes, indeed, many people do.
I tried to be snide and ask him what he would do if the thief came to him to try and get the curse removed and put on the guy that cursed him (fueling a never ending cyclic hell of cursing), but he didn’t really get what I was after.
The Healer’s house, complete with waiting patients.
The healer learned his trade from his parents. He claims that his particular magic is strong because he learned it from his mother (rather than his father). I was told that that was a secret but I guess I’ve let it out. I’m sure it’s still a secret here. (My readership numbers show that it’s a secret anyway.)
He took us back to his house, a shack in a fishing compound on the edge of town, which usually smells of weed. He took us inside and had us sit down on his couch while he started pulling out various bottles and bags of powders. I was sitting next to him. Suddenly he jumped up and insisted that the medicines wanted me to move to the far side of the couch. I asked him if the medicines talked to him to which he replied yes, indeed, they do. I figured out pretty quickly that he’s half deaf and wanted Gabriel closer to him so he could hear.
Medicines
Next, he produced a number of bags of what looked like Indian spices and proceed to mix a heaping amount of what could be easily mistaken for garam masala. This medicine is what’s supposed to cure my diarrheal ills (which he also insisted I had). He poured some in my hand and told me to taste some. I hesitated but did it anyway. Definitely chili peppers in there. My mouth immediately went numb and my head started to spin a bit. Could be something like kava, definitely not weed. I have no clue what’s in this stuff, but there’s most certainly some active ingredient in it. I suspect that he produces it to emphasize his powers.
Magical items
Finally, he recognized that my knee hurts. He asked me if I had time to wait. I said yes, and he left the house to go and get some herbs. We could hear him pounding it into a powder outside. He returned, and said that I should mix the power with Vaseline and cover my entire body with it. I would need a partner to do it. After covering my entire body with the vaseline/powdered grass mixture, I should shake my limbs a bit. After two days, all of my pain would cease. I was to see him again (and again buy more, presumably).
We asked him how much it would be. “This is very expensive. 2,000 Schillings ($24.00).” to which we both balked. Eventually, we talked him down to 500 (about $6.00). Gabriel wanted to talk him down to 100, I just let it go figuring it was a small price to pay for such a weird experience.
Eventually, we had to go. Patients were lined up outside waiting.
The Healer with patients
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- Medicines
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- The Healer with patients
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- The herb that will alleviate my knee pain
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- The Healer’s house, complete with waiting patients.
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- The Healer holding a diarrhea medication and wearing a medicinal herb which alleviates joint pain.
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- Magical items
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- Medicines
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- The Healer’s house
Ruma National Park
Impala
The name apparently has some history:
It was renamed “Ruma” upon request of the local community. The area had been so named by one of Kenya’s most powerful wizard, the much feared Gor Mahia who lived around the park. The park is largely of black cotton soil with surrounding area settled with a mix of small scale cultivation and grassy pasture land.
Gor Mahia is a legendary Luo figure, who even has a book written about him.
Without much else to say outside of complaining about the heat, I leave a few pictures.
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- Ruma National Park
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- Impala
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- White rhino… in the distance
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- Roan antelope
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- Roan antelope
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- Roan antelope
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- Uhh… zebra
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- Zebra
Kenya: Land of Heat, Land of Beef
Kids at the Junction
We went around and continued a survey of shops here in Mbita. Mostly, I tagged along taking GPS readings while secretly dying in the heat. We probably walked more than 10 kilometers total and I probably shook more hands than a politician. All along, I got to hear great tales of employees running away with the day’s profits while the boss is at lunch, stories of false representatives of the “health council” that demand exorbitant weekly payments, how horribly lazy the men of Mbita are, and women who get their hair halfway cut and then run out without paying.
At the end of the day, my survey guy started complaining that he was hungry. To be honest, I’ve never had a survey person ever complain of being hungry. I’ve watched (with awe) Africans go without food and water for far longer than I’m able to. Malawians seem to be able to hold out the longest. (That’s not a generalization. That’s truly my experience.) I have to admit, I was really ready to eat something but was going to hold out until the work was done.
By some bizarre stroke of luck, we happened upon the house of one of the survey managers, who, with no prompting, enthusiastically invited us into his home. Next thing we know, heaping plates of ugali (boiled rice meal) and Nyama Choma (grilled beef and the National Dish of Kenya) are being served up. It was fantastic, of course.
I can’t summon the strength to write much more, so I’ll leave you with a couple of pictures.
Barber shop in downtown Mbita
Small Business in Kenya
Actually, I should title this “Business in Africa” because outside of large mining operations, just about all business in Africa is small. I just walked with my friend Gabriel out to Rusinga island. He had promised to take me to a traditional healer, but, unfortunately the good doctor wasn’t in.
This seemingly tiny community turns out to be a sprawling one. We walked for nearly 2 miles and didn’t see a break in humans once. The walk was a continuum of Cel phone shops, fruit and vegetable stands, butchers, hardware hawkers, electronic shops, cel phone charging places, household and kitchen stores and furniture shops, with the occasional health clinic and school thrown in. It’s the same as just about everywhere else I’ve been in Africa, but while we were walking back I had some thoughts (between moments of trying not to get killed by the motorcycle taxis).
1. African business is the same everywhere. People sell just about the same things, in the same manner as everywhere else. Business models tend to propagate here in ways that they don’t in the developed world, but when something works, it works. The vegetables you find here may not be exactly the same as the ones you might find in Malawi or Ghana, but the selling model is the same: a lady either grows her own or purchases vegetables from a dealer, then sells them for whatever she can get at the market. She then takes the money she earns and buys more the next day.
2. Innovation comes slow here, but when it does arrive, it spreads quickly. Africa’s cel phone model is way ahead of that in the US. We still bog ourselves down with ridiculous contracts and a litany of taxes. I’m no libertarian, but sate and local governments in the US have to get out of the business of regulating communication outside of ponying up money for infrastructure. Cel phones have transformed the continent here.
3. Businesses are way too small. Most are just one person operations that work with no budget, no access to capital and no ability to expand. To make matters worse, the litany of tiny, tiny businesses means that proprietors can’t take advantage of bulk discounts, and, even worse yet, dilute the available market share so thinly that they can’t depend on a regular customer base. Prices depress to rock bottom levels, to the point where businesses are selling goods for less than wholesale, simply in the hopes of keeping customers. The model is exciting, but wholly unsustainable. Because people are so used to working for nothing and have few other options, it continues. It is contexts like this where the free market fails everyone. Better regulation, licensing and standards would improve the situation for everyone, but that’s a tall order in politically troubled areas like Kenya.
