Apparently this animal was found in the Bui Dam project in Ghana. It is thought that this horrific beast, not shoddy construction by the Chinese contractor building the dam, was responsible for a dam collapse the same day. It is reported to have the head of a human, two claws to pull itself along and the body of a snake. Though the video doesn’t seem to confirm it, reports indicated that it is more than 100m long.
We need to be on the lookout for beasts such as this all over the globe.
It was announced to day that Barack Obama will appoint Dartmouth President and physician Jim Yong Kim to be the next head of the World Bank. This breaks a string of appointments of right wing demagogues including Paul Wolfowitz and Robert Zoellick, both part of the group which orchestrated the invasion of Iraq and the heavy handed response to 9/11 by the Bush admin. I saw Zoellick speak recently and felt kind of gross after it was over.
Jim Yong Kim has an impressive list of publications on global health, notably collaborating with Partners In Health founder and human advocate, Paul Farmer. In fact, Kim was also part of the group that founded PIH and is known for his work on “Social Medicine” (a broad signifier for social determinants of health with a focus on clinical delivery).
Kim is co-founder of The Global Health Delivery Project, a group at Harvard that seeks to improve the health and welfare of population in developing countries by focusing on issues of health care delivery.
Problems of delivery of health care in developing countries has been perhaps my number one interest as of late. In fact, I am even writing a paper on it. As researchers, we can develop effective and radical new clinical techniques and medicines, but they do no good if the systems aren’t in place to deliver them effectively. Issues of delivery will be the primary impediment to controlling and eventually eliminating devastating diseases such as malaria. It is encouraging that Kim has been selected to fill this position.
It is unsurprising that Columbia University development economist Jeff Sachs was not chosen (he has withdrawn his nomination), despite appealing to the world community to pressure the Obama admin to select him. However, it is a relief that the first choice, Larry Summers, has to forego stepping in to a leadership position at the WB. I can think of no WORSE choice. The entire world appeared to agree and it marked the first time that the international community has had a say in who heads the Bank, a welcome departure from past appointments.
Sachs himself even came out in support, likely aware of his role in having Kim picked: “Dr Jim Kim is a superb nominee for the World Bank presidency,” Sachs said in a statement. “I support his nomination 100 percent. I congratulate the administration for nominating a world-class development leader for this position.”
I am interested to learn more about Kim. He may certainly have some ideological skeletons in his closet, though his association with Farmer leads me to think not. Congratulations to the Obama admin for taking the high road on this one.
UPDATE: OK, so it appears that Kim will be the first WB President to ever be caught on film rapping and dancing at a Michael Jackson tribute:
Filmmaker Jason Russell has put together a slick 30 minute feature on why the world should be concerned about Joseph Kony and the LRA. It is well done piece that documents Mr. Russell’s journey to Uganda and the events which led to his eventual commitment to the issue of the LRA and child soldiers. More than 60 million people have viewed the video, and has turned into a (likely temporary) viral sensation.
The intent of the film is obscure for the first ten minutes, starting out with a primer on how people in the United States spread videos of their kids on YouTube and Facebook. Soon, after several grueling and annoying minutes watching videos of Mr. Russell’s own child, we figure out what the video. All is explained in a conversation between Russell and his 4 year old son.
The video is not without critics. I am one of them. On the surface, the video is a call to action from a concerned filmmaker. Mostly, though, it is less documentary and more a shameless advertisement for the filmmaker himself. Russell even goes the extra step to try to sell the viewer Kony “Action Packs” (it sounds like something that comes out of a cereal box). For $30, you get a button and a couple of wristbands, one for yourself and one for a friend. For $30 you can feel like you did something for helpless kids in Uganda.
The trouble is, though, that Kony hasn’t been in Uganda since 2005 and Ugandan kids won’t likely see much of that money.
While Kony is a perfect evil-doer in the deeply scary continent of Africa, he is certainly not the scariest killer of children. More than one million kids senselessly die every year from malaria. Another million die even more senselessly of diarrheal diseases from drinking contaminated water. More than 30 million kids have been orphaned due to HIV. Worse yet, many millions of the kids that didn’t die after getting sick suffer from serious (though poorly researched) developmental problems. These not only pose incredible problems for the kids themselves, but are a serious impediment to the development of poor countries. If the video is any indication, Russell appears unconcerned.
Though not to discount the horror the man has committed, by comparison Kony is a small threat. The image of Kony, however, feeds into Western perceptions of Africa as being a really, really frightening place (despite the fact that people like Robert Mugabe kill more people than Kony through irrisponsible leadership). Africa is seen to be as a place of continual conflict and instability. The only way to fix it is to send in white people to protect African kids from African adults. Not only is it the only way, but we have a duty to act immediately, or more kids will die.
In the manner that it uses social media, slick production values and a sense of absolute immediacy and simplicity, it is quite similar to campaigns such as the One campaign and Product (RED). It is also similar in that it uses African crises to sell itself and its own products, while giving little to the subjects concerned. Worse yet, it gives little airtime to the numerous African led groups working day and night to solve Africa’s seemingly insurmountable problems.
To me, the real problem with groups like Invisible Children is that it presents a world where the individual, voluntary and one time actions of consumers are an easy solution to the complex problems of developing countries and global health issues. What this does is distract policy conversations from creating sustained and cooperative strategies for poverty alleviation. It allows corporate and government entities to operate with little scrutiny, despite being responsible for (and profit from) creating conditions of entrenched inequality around the world.
No doubt, Russell will have his supporters. Americans like to feel good and it makes them feel good to send in a little money, watch a video, wear a bracelet and save kids in Africa.
A new World Bank report on the state of poverty in the world suggests that the number of people living on $1.25 a day have declined over the past decade. Even raisig the bar to $2.00 a day indicates great gains in the world fight against poverty.
Much of the improvement in world poverty numbers come from Asia, specifically China, which can boast that nearly 662 million people now no longer live on less than $1.25 a day compared to 1981. In 1981, nearly 77% of people in East Asia lived in poverty. Now, only 14% do.
Though this is cause to celebrate, the world is not out of the woods yet. Africa, though slowly recovering from the disastrous structural adjustment era, which erased previous gains in poverty reduction, still provides home to large numbers of ultra poor households, particularly in rural areas. Nearly 45% of Africans live in poverty at present.
One should praise the great successes of economically emergent Sub-Saharan African countries. One should not forget to ask why Asia has been a success story and why Africa has not. Most relevant, the World Bank should at least make mention of their complicity in creating conditions of entrenched poverty in Sub-Saharan Africa.
When I saw Robert Zoellick of the World Bank last year, he only made passing mention of the programs which erased Africa’s past economic gains, dismissing the matter as a fringe concern of political freaks and over-reactionaries. The simple truth is that it is impossible to dismiss policies which have favored narrow US interests and reflected a narrow view of economics only appropriate for the most developed of countries, policies which have been implemented at the expense of the very poor.
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.
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?
[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]
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.
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.
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.