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Mbita, Kenya

I’m too busy writing other things to actually write anything for this blog, so my two readers will have to suffice with pictures.

Right now, I’m in Mbita, Kenya, located in Nyanza Province. The area is known to be one of the least developed places in all of Kenya, but has to be one of the friendliest. It’s not hard to find someone to talk to, and even easier to get their picture. Most times, they ask you to take one.

Zanzibar

I’m having good luck this hour with the internet connection here, though that is always subject to change. To make up for lost time, I’m going to post some pictures from my recent visit to Zanzibar.

Zanzibar has to be one of the strangest places I’ve ever been. In addition to its intensely long history and deep cultural flavor (or flavors, one of its main exports is spice), it is notably the birthplace of Queen’s Freddy Mercury. Freddy lived here until the Zanzibar Revolution of 1964, when his Iranian parents had to flee what turned into a bloody genocide of Arabs and Asians. Without that violent chapter in Zanzibar’s history, Queen would have never come to be.

Regardless, it’s an amazing place and potentially the only place in all of Africa where women and children are free to walk around unaccompanied at all hours of the night. It’s certainly the first time I’ve ever seen families in African out on the town, enjoying great food by the water.

Tanzania Day 6: The Road

It takes more than 20 hours to get from the eastern coast to the western end of Tanzania. Though the road is largely paved between Dar es Salaam and Mbeya in Rukwa Region, areas in more remote sections of Tanzania are what one would expect: hills, rain swept crags and valleys, and treacherous mountain paths. Compounding this distance is the multitude of police stops along the way.

So far, we’ve had to pay fines for “speeding” and not having a sticker that no one seems to have heard of-though I suspect that it’s a permit for carrying white people in the country of Tanzania. As I’m writing this, we’ve just been stopped for doing 40 in a 30 zone, which set the driver back about $10. In total, we’ve been stopped more than 10 times and I don’t expect it to end anytime soon. I’m reminiscing about driving through Tennessee, where cops will pull over anyone with an out of state tag and concoct any number of fine-able “offenses.” No one asks specifically for a bribe, but it’s pretty clear that the police are pocketing the “fines.”

This is the main artery that connects the ports of Dar with Malawi, Zambia and the DRC. Back to back trucks take goods in and out of Tanzania all day long. Gasoline and diesel appear to be the most transported items, followed by Coke and Pepsi bottles both empty and full. Trucks carrying farming and construction equipment are not rare. It’s reassuring to see flatbeds carrying brand new Massey tractors toward Malawi and Zambia.

It’s the harvest right now, so farmers are busy bagging rice and loading them on to large trucks for consumption in other areas of Tanzania, and presumably for export to other countries. This area is famous for rice, and I can attest to the quality. Wood is also in plentiful supply. Trucks full of African mahogany that would bring hundreds of thousands of dollars in the US are to be seen everywhere.

We pass through Tunduma, on the Zambia/Malawi/Tanzania border. The air here in this border town is thick and black with exhaust. Its remnants coat everything in sight, even the humans, leaving it a dull and dirty brown. If I were to spend any more time here, I’m sure my lungs would begin to hurt. Looking around at all the auto parts shops, it’s probably the best place in this region to go if you’re looking for parts for your Scania truck, presumable scavenged from the series of metal husks that adorn the sides of the road. Most are half buried from the rains.

Just got pulled over again, this time for a hanging cooling belt. This time, we don’t have to pay. While we’re all thankful to know that the cooling belt needs to be replaced, the driver remarks that this road is notorious. What should be an 8-hour trip from Mbeya to Dar turns into twelve due to all of the pointless police stops.

The drive on the way back is a harrowing series of mountain paths and thin highways. Cows, goats, baboons and children present constant hazards. By far, though, the most dangerous parts of the road here are the vehicles. Even the largest of trucks run long past their date of expiration. It isn’t at all reassuring to remember that the number one reason that people decommission their vehicles is the expense of repairing worn brake lines. Engines can be replaced. Safety is another matter entirely.

We see the remains of not one, but several horrific truck accidents. Even if the drivers survived the crash, it’s unlikely that any hospital in Tanzania would be equipped to provide adequate care to manage massive blood loss and trauma. Honestly, I wouldn’t want a transfusion here anyway. It is notable that as we approach Dar and the road widens, the number of accidents appears to dwindle. I become more and more at ease the closer we get. I have to admit, though, my worries are likely overblown and unwarranted, but it never hurts to be careful.

Tanzania – Sumbwanga Rural

20120501-202942.jpgWe’ve started our visits to drug shops in this region of Tanzania, which mostly entails sitting alongside interviews in Swahili and waiting long hours for customers to show up. It’s a national holiday so everyone must be busy attending to children at home, cause noone seems to be interested in buying pharmaceuticals today.

This village sits on the outskirts of Sumbwanga town in Rukwa Region. The local economy is based on agricultural trade and local buying and selling of goods available anywhere in Sub Saharan Africa. The market consists of the usual fare, soap, haircuts, soft drinks and beer, but sports a variety of dried fishes and local fruits. I pass on the dried fish as delectable as it looks. The omelet with French fries is also out, sad to say. The oranges, no problem.

Like most places in Africa, people are very kind and will repeatedly thank you making the long journey to their very small and mostly unknown village. Here, so close to friendly and peaceful hotspots like Malawi and Zambia, extreme kindness is a given.

The only business here is small business. Like everywhere in Africa, businesses are informal, sole proprietorships. The drug shops are no exception. I spoke with two shop owners today, both were trained as nurses, but left public service to open or work at small drug shops.

The relationship of drug shops with the public system is worth noting. As the public system in Tanzania relies completely on government revenue and donor aid to function, drugs are often unavailable. In theory, this opens a market opportunity for private shops but in reality it appears that public employees are funneling drugs to shops they have a stake in, as a recent scandal has unveiled.

I spoke with a gentleman today who may be considered exceptional, but likely isn’t. 20 year old Charles, living in an extremely remote town worked burning charcoal for pennies, saved his earnings and opened a small shop, debt free. Now he sells soap, cooking oil and single cigarettes from a small storefront adjacent to one of the drug shops we visited. He would like to save his money and open a shop which sells lights, generators and electrical goods aimed at other shops.

One common misconception about Africa is that Africans lack an entrepreneurial spirit. Far from it, what they actually lack is capital.

All Africans are entrepreneurs. Americans on the other hand mostly just draw paychecks.

Tanzania Day 1,2,3

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Third day in TZ. Now that I don’t feel like n octogenarian, I might be able to put together a few comprehensible sentences.

Flew into Dar on Saturday after a grueling flight. Had the pleasure though of sitting next to a group of jolly Hungarian engineers. They were being chaperoned by two Catholic priests who proceeded to repeatedly order whiskey shots for everyone in the vicinity. Catholicism has its finer points.

Dar is bustling. A port town, it is the main point of entry and exit for all goofs bought and sold in TZ. Not nearly as walkable as Blantyre, and not neatly as dangerous as Nairobi. It’s q good mix, plus there’s great Indian food for cheap. TZ has some great seafood.

Left Sunday to make the 20 plus hour trip to Rukwa. Odd seeing zebras and elephants from the highway, but frightening to see the remains of multiple highway accidents. Still, the roads here are far superior to that of Malawi, and the vehicles acceptable.

Road construction is happening at a breakneck pace here , even in the far reaches of nowhere. Trucks line the highways bumper to bumper signaling a rapidly growing economy. Almost everything is available everywhere and it’s only getting better.

Western TZ is gorgeous. Just saw a sign for Malawi. Only a few hours apart but worlds apart economically.

That’s all for now…

Emerging Drug Resistance in Thailand Threatens Malaria Eradication

The Lancet recently published the results of a longitudinal study examining resistance by malaria parasite to the latest and most effective treatment for the disease, Artemisinin Combination Therapy (ACT) along the Thai-Myanmar border.

Parasite clearance rates increased from a mean half life of 2.7 hours in 2001 to 3.6 hours in 2010, indicating that resistance is growing. Resistance was originally observed on the western side of Cambodia, but has now either spread geographically to western Thailand or emerged on its own. The latter scenario is actually the more frightening possibility. If resistant strains emerge in Sub-Saharan Africa, it could be a major setback.

Though research to develop new drugs is ongoing, ACTs are presently the most effective treatment and a major part of the arsenal with which to stop transmission and prevent early childhood death. Past treatment strategies are now largely ineffective.

Vaccines are also in development (most notably the RTSS vaccine), though I have little confidence that it will be of much use for long. It is a long series of shots and difficult to deliver in areas where medical delivery is poor or non-existent and efficacy is strain and context specific. Malaria vaccines are nice in the popular press, but impractical on the ground.

That resistance is growing in this particular end of the world, is in itself significant. Both regions are notable for poor health delivery, sporadic armed conflicts and marginalized populations. Efforts to contain the spread of resistance are likely futile. Even in the best of times, adequate delivery of care and prevention strategies are near impossible. Displacement of people due to conflict always provide ample opportunities for infectious agents, poor health and death. Tens of thousands of people languish in refugee camps along the border.

The subject of resistance in this region comes up often in meetings of malaria researchers, though I am always struck at the absence of discussion of social factors and conflict and how they create conditions favorable for the spread of resistant pathogens. It is no accident that malaria occurs in the places it does, and no accident that resistant strains of Plasmodium are able to fester and evade efforts to reign it in. It is almost as if the malaria research world believes that genetic adaptation happens at random, which it does not.

Discussion of malaria eradication cannot proceed without discussion of how to eradicate worldwide conflict, entrenched poverty and proper delivery and access to basic health care and the global forces which create these conditions. Yet it does.

Medications, vaccines and preventative interventions cannot work if there is no way to delivery them, and people cannot access them unless there is a local economy with which to support such a system. Malaria research has to address this fundamental issue or we’re just talking in the wind.

Malawi’s President Bingu Dies Due to Drug Shortage: Chaos Reigns

Malawi’s President Bingu, or as he was officially known “His Excellency the President Ngwazi Professor Bingu wa Mutharika” died last Thursday.

His death has left a power vacuum in Malawi. Joyce Banda, the current Vice President constitutionally is expected to take power, but members of Bingu’s Democratic Progressive Party are seeking to block her appointment. Banda, though chosen as a running mate by Bingu himself, increasingly found herself at odds with Bingu’s increasingly autocratic Presidency and ultimately left the DPP to form her own political party. Bingu sought to cancel her vice presidential seat unsuccessfully. The Malawian Supreme Court ruled that she was still entitled to the seat.

Both groups within and outside of Malawi are calling for a swift transfer of power to Banda, including the United States.

Malawi could do worse than Banda. A former educator, Banda has sponsored numerous initiatives to expand educational opportunities for children and to increase female empowerment within Malawi. Since 1990, Banda’s National Association of Business Women has provided support and training for female entrepreneurs, reaching a wide network of approximately 30,000 people. She has sponsored health initiatives in Malawi and won numerous international awards. Most impressive, she quietly sponsored a task force to determine the extent of HIV in MSM populations, a dangerous undertaking in conservative Malawi. Forbes magazine listed Banda as the third most powerful woman in Africa. In short, Banda could be the breath of fresh air that Malawi requires.

Mutharika’s Presidency, though initially lauded due to his successful seed voucher program, which he boldly implemented against the advice of the World Bank and the IMF, fell into disgrace due to widespread fuel shortages and a dearth of foreign exchange. The increasingly dire situation led to mass protests all over Malawi, a state crackdown, and the deaths of 19 people. It is questionable though, as to whether Banda can solve these problems, much of which is due to international market forces out of the control of the domestic Presidency.

Of interest to me were the circumstances of Bingu’s death. Bingu collapsed on Thursday night and was rushed immediately to Kamuzu Central Hospital, a public facility. Upon presentation at the Kamuzu, workers realized that they were lacking epinephrine and had to run to a facility run by University of North Carolina to procure it. Bingu likely died because of problems of drug stocking in Malawian facilities and substandard levels of health delivery. Bingu died due to a problem endemic to all of Malawi. Ironically, the opulent President of Malawi died needlessly like that of even the poorest of Malawians.


Network Analysis Exposes Kony 2012 As Right Wing Christian Propaganda

"I want to masturbate in public"

Readers of this blog (all 2 of you) are well familiar of the intense skepticism I hold for evangelical Christian groups operating in Africa (and everywhere else).

Forbes magazine ran a fascinating piece on Social Flow. Social Flow used their network analysis software to track connections between Twitter feeds that all had “#Kony2012″ in the text.

What they found was nothing short of illuminating. A visualization of the data can be seen at the bottom of this post.

We expect that connected Twitter users will be linked by geographic region and would expect more connections in large urban areas such as New York and LA. Far from being clustered in metropolises, people promoting Kony 2012 were located in smaller cities, such as Pittsburgh, Dayton, OH, Birmingham, AL and Noblesville, IN (wherever that is):

“The large cluster on the top right includes users from Birmingham Alabama who were some of the earliest to publicize the video. The cluster is substantially larger than the others, leading us to believe that Invisible Children had strong roots in Alabama. Additionally, the hashtag#Kony2012 initially trended in Birmingham on March 1st, a few days before the video was even placed online. Other clusters in the graph include Pittsburgh, Oklahoma City and Noblesville Indiana.” But not only were there geographical clusters, but cultural clusters as well, “This movement did not emerge from the big cities, but rather small-medium sized cities across the Unites States. It is heavily supported by Christian youth, many of whom post Biblical psalms as their profile bios.”

Amazing. Kony 2012 billed itself as a happy accident. The evidence indicates that this was a well coordinated, well funded campaign waged by a powerful religious group. “Stealth Evangelism.”

Talk To Action (thanks Jeff) is a secular watchdog organization devoted to exposing the (in my opinion) damaging and self-serving influence that the religious right has on American politics. They have recently done a series of posts on Invisible Children and the Kony 2012 campaign. The more I read about this and the more I find out about this organization, the weirder it appears to me.

Talk To Action has done some digging and found that Invisible Children receives funding from the Family and other right wing Christian sources. The Family are a powerful, though secretive US fundamentalist group and were behind Uganda’s reprehensible Parliamentary bill which called for the execution of anyone suspected of being a homosexual. Though the group denies this is the case, the evidence against them is fairly damning. It appears though, that the Family are behind much of the recent Kony 2012 craze.

Invisible Children’s founder (and creator of the Kony 2012 video) Jason Russell was heard saying the following, where he admits that IC is using the issue of suffering kids in Africa so that his batshit religious group can gain access to kids in public schools:

“Coming in January we are trying to hit as many high schools, churches, and colleges as possible with this movie. We are able to be the Trojan Horse in a sense, going into a secular realm and saying, guess what life is about orphans, and it’s about the widow. It’s about the oppressed. That’s God’s heart. And to sit in a public high school and tell them about that has been life-changing. Because they get so excited. And it’s not driven by guilt, it’s driven be an adventure and the adventure is God’s.”

This is, of course, before he got caught running around town publicly masturbating.

Hideous Dam Destroying Beast Found in Bui, Ghana

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.

Breaking Tradition, a US President Appoints Human (and Rapper) to Head World Bank

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:


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