Not that the Economist has ever made a habit of ignoring tropical diseases. Far from it, the Economist as a British magazine is quite good at reporting on the Isles former colonies.
Here they’ve written on the issues of mass drug administrations as a tool in malaria eradication. Specifically, they focus on a Chinese group seeking to ramp up efforts to create a successful regimen of artemisinin and piperaquine to eliminate the disease by prophylacticly preventing infection, and interrupting the cycle of transmission long enough to eliminate the parasite entirely.
Dr Li’s approach is to attack not the mosquito, but the disease-causing parasite itself. This parasite’s life cycle alternates between its insect host (the mosquito) and its vertebrate one (human beings). Crucially, as far as is known, humans are its only vertebrate host. Deny it them and it will, perforce, wither away—an approach that worked for the smallpox virus, which had a similarly picky appetite. In the case of smallpox, a vaccine was used to make humans hostile territory for the pathogen. Since there is no vaccine against malaria, Dr Li is instead using drugs.
To date, the group has been running trials in the Comoros islands off the coast of Mozambique and had some success, but haven’t come close to full elimination. Elimination on islands surrounded by salt water (mosquitoes which transmit malaria breed in fresh water) should be a fairly easy proposition, but the issue of human mobility from the African continent guarantees reintroduction.
I’m personally involved in an island malaria elimination project in Kenya, but am under no illusions that results from an island are in the least bit generalization to the continent. Falciparum malaria is far too efficient and the lack of a winter renders transmission far too consistent to allow easy elimination. Add the issue of the intense mobility of Africans and one can’t help but be discouraged.
Dr. Li from the Guangzhou group seems to be optimistically under the mistaken impression that all it will take to eradicate malaria is the right combination of magic pills, but he’s gravely mistaken. The only thing that will consistently control malaria on the continent will be a full on, sustained assault using every tool known, along with intense economic development. The continent has only seen gains in malaria control during the 00′s, when incredible amounts of money and effort was thrown at the disease and, not coincidentally, when African economies finally started to take off. Eradicating malaria won’t be about a few pills.
More troubling to me are the ethical issues. Mass drug administrations require the participation. If even a small group of people refuse the medication, the entire effort might be for naught. Obtaining full, informed consent, however, is near impossible in these areas. While most people are willing to participate once the benefits are explained to them, the risks are often glossed over. Moreover, as communities will often follow the behavior of their neighbors or community leaders, it is difficult to judge whether people participate of their own volition or whether they are merely bowing to community pressure. Educational barriers might also compromise the ability to obtain truly informed consent.
Further, I don’t doubt the intent of the Guangzhou group, but I do wonder if Chinese institutions truly have the same level of ethical review and monitoring that United States’ institutions have (which isn’t even perfect and sometimes ill suited to developing countries). I’m sure that China would love to claim a success like malaria elimination, but I worry that a zeal for victory might lead to a violation of basic ethics and even a masking of failures, complicating the issue in the long term. I hope that I’m wrong.
Every year, Bill and Melinda Gates release a letter on the state of the Gates Foundation and the current situation of global development and health. This time Gates set out to dispel three common myths on development, namely that poor countries are doomed to be poor forever, foreign aid is a total waste and that development will just lead to overpopulation.
The first is the most cynical, but even for us development/public health folks, it’s easy to be discouraged. Pessimism aside, the data don’t bear out the assumption that developing countries are entrenched in poverty. Just about all Sub-Saharan African countries experience consistent economic growth throughout the 00′s and have seen rapid improvements in just about all of the common health indicators. People are living longer, fewer kids are dying and they’re making more money to pay for school and health care.
Over the past five years that I’ve been going to Sub-Saharan Africa I’ve seen this change on the ground. Cars are in better shape, there’s more goods on the shelves, kids are better nourished and security has vastly improved. Does this mean that all of the problems are magically going away? No, there are still vast challenges to infrastructure development, access to health care and affordable medications, educational quality, gender issues and basic business development. However, these improvements do signal that Sub-Saharan African countries are reaching a point where sustained development is possible.
I have a hard time disagreeing with Gates here, but I did find his “before” and “after” pictures of Nairobi a bit bizarre. Though Nairobi is currently going through a construction boom, I fail to see how it would look any different in 2014 than it did in 1969 after more than three decades of stagnation.
Gates second point and the hardest myth to dispel is that of the alleged ineffectiveness of aid. Bill Easterly has made a career out of aid bashing, and, unfortunately, given cynical politicians looking for policy scapegoats a point to scream to their angry constituents. In a broader sense, the screaming over aid is really a questioning of developmental policies themselves. Certainly, there are development failures. The neo-classically informed structural adjustment policies of the World Bank and the IMF during the 80′s and 90′s were, on the surface, colossal failures (Read Beyond the World Bank Agenda: An Institutional Approach to Development by Howard Stein for a great analysis). On a smaller scale, we can easily cherry pick misguided but well meaning development projects or plans that simply went awry for any number of unforeseen reasons. The recent takedown of Jeff Sachs (The Idealist: Jeffrey Sachs and the Quest to End Poverty) and the massive problems of the Millenium Village in North East Province in Kenya is a great example of the challenges a development project can face.
However, in ever insular post Iraq America, the question that is most often asked is why we should even care and does our presence merely serve to make things worse. The truth is, and the point most often overlooked, is that most development projects are international collaborations. Many projects are conducted with partners in target countries and, more often than not, projects often make up for shortfalls that hobbled governments are unable (or sometimes unwilling) to provide. Health care is one example.
Jeff Sachs wrote a nice article this morning on how effective free insecticide treated nets have been in reducing malaria incidence and mortality in Sub-Saharan Africa. Nearly half a billion free nets have been given out worldwide as of 2014 and a lot of kids are alive today who would have been dead had they been born ten years earlier. Malaria is 100% associated with poverty. Wealthy people do not get malaria, even in malaria endemic countries. Though some of the decline in malaria incidence has been due to increased affluence and urbanization of African countries, a major percentage of this decline has been due to aid programs which provide bed nets and have expanded access to life-saving malaria medications. Certainly, not all aid works, but nothing works 100% of the time, particularly when humans are involved.
Which brings us to the most cynical and offensive of Gates’ three myths. Some people truly believe that saving African kids is a bad thing. One day there will be too many of them and they will suck up the ability for the world to sustain life. Honestly, this view couldn’t be more wrong.
The poorest parts of the world are the areas which are seeing the most rapid population growth. The average Malawian woman has 8 children in her lifetime, often starting when she isn’t even yet 15 years old. It has been said that if Malawi continues on it’s current trajectory, that it will have a population equivalent to that of Japan’s by 2050. Women in water and food constrained pastoralist communities can have ten or more children. The most affluent areas of Africa are the places with the slowest population growth.
Even more incorrect is the assumption that poverty is less harmful to the environment than development. Malawi is almost entirely deforested due to extensive use of charcoal for heating and tobacco cultivation. Deforestation not only robs the earth of potential carbon sinks, but also reduces need biodiversity and directly impacts precious water resources. Africa burns unclean fuels such as charcoal and coal for heating, and the poor condition of vehicles make it a major potential source of greenhouse gases. The air in Nairobi on any given weekday is so filled with exhaust that one can become dizzy just walking around town. It is, of course, unreasonable (and stupid) to deny Africans transportation and cooking fuel, but well meaning though poorly informed armchair environmentalists in the United States would happily suggest doing just that.
Which bring me to my final point. The case against development is one that assumes that the status quo is somehow preferable to anything that might come after. The assumption is that Africans were just fine without Europeans and their planet destroying ways. There is, of course, little data on what Africa was like before Europeans started extracting resources from the continent. We do, however, know a lot about underdeveloped areas of Africa. There is evidence to suggest that some do fine. There is however, much evidence to suggest that other simply do not. The worst parts of Africa are the parts which are the least developed. They are the areas where the market doesn’t function. The areas where there is little education, no access to health care, no roads, no economy, kids regularly die, where old people are a venerated since they are so rare, where there’s violence and instability and people are entirely marginalized from any level of political participation. While development likely will never solve the worst problems (like those in Somalia), there is no case to be made that the current state of the ultra poor is acceptable on any measure, even to the poor themselves!
Alright, off to bed.
Africa is an awful place to be gay, but, just as everywhere else, gay folks exist and do the best they can under adverse circumstances.
Happily, President Museveni of Uganda has stated that he refuses to sign a “anti-homosexuality Bill” sent to him from the Ugandan Parliament. It’s possible that he would have supported had he sensed that signing the bill would have benefitted him domestically, as Nigerian President Goodluck Johnathan (who’s luck seems to be running out) did just this week.
Wasting no time at all, Nigerian authorities have arrested and tortured dozens of people suspected of being gay. The methods are frightening:
Human rights advocates in Nigeria are reporting that dozens of gay men have been arrested under a new law that makes homosexual clubs or associations illegal. That law also criminalizes same-sex marriage. Gay men who have been arrested have reportedly been tortured into giving up the names of others. Michelle Faul with the Associated Press has been writing about this and she joins us now from Lagos.
And Michelle, why don’t you give us more details, what you’ve learned about these arrests and the reports of torture from human rights groups there.
MICHELLE FAUL: As we’re speaking, Melissa, we’re getting more reports in of more people being arrested in about six of Nigeria’s 36 states. I’ve spoken with human rights activists here who say this has not just happened since the bill was signed into law, but since there’s been noise about the bill. So the very idea of the bill has led to this persecution of people because of their sexual differences.
BLOCK: And in particular the reports of torture, what have you heard about that?
FAUL: That particular report comes from Bauchi State in the north of Nigeria, where it’s almost a case of entrapment. A law enforcer pretending to be a gay man went to a meeting where an AIDS counselor was speaking to men, who have sex with men, about how they could do this safely. He pretended to be gay, got the names of a couple of people, arrested subsequently one person, used their cell phone – this is illegal in itself for him to go through this person cell phone, contact another gay person and another gay person. Called them for a meeting, arrest them, take them to the police station and beat them up repeatedly and brutally until they gave up 168 names of people who were supposed to be gay.
But back to Uganda. Museveni has a thin road to walk. If he comes out on the side of Uganda’s very active gay rights movement, he risks losing crucial domestic support. If he would have signed the bill, he risks losing international support at a fragile point in Uganda’s development.
He plays it carefully, but offers a few bizarre ideas:
The President said a homosexual is somebody who is abnormal because the normal person was created to be attracted to the opposite sex in order to procreate and perpetuate the human race. He said, nature goes wrong in a minority of cases.
While in the Bill passed by Parliament there is no provision for killing homosexuals; the President said, “The question at the core of the debate of homosexuality is; what do we do with an abnormal person? Do we kill him/her? Do we imprison him/her? Or we do contain him/her?”
While the President said homosexuality is an abnormal condition that can be cured, he disagreed with the position of Western countries that homosexuality is an “alternative sexual orientation”. “You cannot call an abnormality an alternative orientation. It could be that the Western societies, on account of random breeding, have generated many abnormal people,” he said, adding that his acid test for rejecting Western position is that nature is purposeful.
The President said apart from the people who are abnormal, it seems there is a group of those that become homosexual for “mercenary reasons”—they get recruited on account of financial inducements. He said this is a group that can be rescued and that many of the youth fall in this category.
I’m not following his logic here. I seriously doubt Museveni does either. Though he says that homosexuality is a natural condition, he also tries to claim that young men become gay to make money. The former presents him with a problem. If homosexuality is to be considered an unfortunate genetic outcome, the state has no right to inflict punishment on the individual any more than on a person born with any other type of genetic defect.
The latter, I’ve heard before. NGOs allegedly come to Africa and recruit young men through promises of money and passports. There is no reason to discount the problem of prositution enabled by economic inequality. We’ve seen it elsewhere (a movie was even made about an Irish author’s disgusting sexual adventures in Nepal). Of course, the Ugandan and Nigerian Parliaments seem to be doing little to curb the much larger problem of female prostitution in Uganda and it’s difficult for me to understand how it’s at all relevant to the lives of people peacefully living their lives who happen to be gay.
And this is of course where the problem lies. Homosexuality makes for an easy target for Christian conservatives in Africa (often egged on by western missionaries and evangelicals). However, there is little outrage over extramarital affairs, child rape, and the buying and selling of women, an obviously greater social problem. But policy makers worldwide often like to pick on those who are unable to defend themselves.
How do the governments of Nigeria and Uganda have time for all this? In countries where half the population lives on a dollar a day, the problem of delivering food and health care would seem to be more pressing issues. Many people I know like to blame the West for all of Africa’s ills. Clearly, as these examples show, policy makers in Nigeria and Uganda aren’t in the least bit interested in the welfare of their people, preferring to weed out minor issues of “gays” than deal with important matters such as food, health and stability.
He hired sex workers in Ecuador and Mexico to interview other sex workers employed in brothels and as street prostitutes. As sex workers have a keen sense as to what clients consider “beautiful,” he relied on them to scale their looks fairly.
As much of sex work relies on friendly interactions with clients, survey staff were also instructed to assess communication skills. Sex workers were asked to report the number of hours worked in the previous week, the number of clients and the time spent with each.
Sex workers in Ecuador reported making approximately $5 per hour, where Mexican prostitutes made nearly $12 an hour. Most prostitutes worked a 40 hour week. A Mexican prostitute can expect to make about 5 times the income of an average household there. The payoff in Ecuador is somewhat less but still higher than the average.
About three quarters of each had children and between 20 and 50% of them were married. Around 1 in 10 Ecuadorian sex worker tested positive for an STI.
Arunachalam found that beautiful sex workers in brothels tended to spend more time working, more time with clients and made more money per transaction. Attractive sex workers earned approximately 15% more than average and unattractive prostitutes.
He also found that while beautiful women tended to be more likely to work in brothels, where hours are fixed, than as street prostitutes. The pay off for beauty on the street tended to be higher on the street than in brothels, however.
Beauty payoffs have been seen in other employment contexts. It has been associated with a decreased risk of being involved with crime, the likelihood of happiness, securing a job, success in politics, and in generating positive reviews from University students.
The paper “The Prostitute’s Allure: The Return to Beauty in Commercial Sex Work” is available here.
OK, back to work.
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.
Andrew WK is a rock star, composer, motivational speaker, Taco Bell enthusiast, television host, inventor and (very) part-time painter based in NYC.
Andrew was a student of mine (I gave him an A- and got him grounded) when I was doing a volunteer teaching gig at Community High School in Ann Arbor, MI in 1994. We became acquainted, played in a couple of bands together, and later I put out a couple of his records on my BULB record label. Most important to me, however, is that he’s a good friend.
A couple of weeks ago, it was suddenly announced that Andrew would be serving as a “United States’ Cultural Ambassador to the Middle East.” Andrew would be travelling to the Kingdom of Bahrain on behalf of the US State Department, where he would be spreading his positive “Party” philosophy (the freak out, good time sort, not the divisive Democratic/Republican kind). Not more than 24 hours after I heard the announcement, however, news appeared stating that the entire trip had been cancelled. Many of us were scratching our heads, wondering if the entire thing was a stunt. Fans of AWK have been known to start and passionately spread odd rumors in the past.
However, several media outlets ran articles that included a transcript where a representative of State mentioned the trip and its subsequent cancellation. The State rep was quoted as saying “There may have been some preliminary conversations with him, but he will not be going to Bahrain on the U.S. government’s dime.” Andrew’s scheduled trip to represent the US was very real.
Bahrain is a particularly troubled place right now. Protests have rocked the tiny, oil-rich nation but the heavy handed monarchy has managed to brutally stifle much of it. Bahrain’s human rights record has been described as “dismal” by Human Rights Watch. Sending someone like Andrew, whose positive, self made image very much represents the ideals of liberal, free market democracy would actually be a perfect choice to represent the US in this difficult time.
Perplexed the whole thing, I decided to reach out to Andrew and get the full story. Andrew was kindly able to take some time out to answer some questions about the incident. First, I would like to thank Andrew. Here’s the interview:
A: We were cold called, but there had been some murmuring about me traveling abroad in some capacity for a few years. We first officially heard from the State Dept. on September 13th, 2011. That was when they wrote to us with an official invitation reading, “Department of State sponsored trip to Bahrain for motivational speech”.
FB: I’ve read that someone from Bahrain specifically made a request to the Embassy there.
A: We had never heard anything about the trip being requested by a citizen of Bahrain, but I had heard rumors from my managers that they were approached about an entertainment project with the U.S. government. We didn’t know what it was exactly until we got the official invitation. It was always presented as a government sponsored event to spread good will and cultural exchange between the U.S. and the middle east. The people who I work with and who help plan my career have always worked on ways to help further the cause of uniting different cultures and promoting the coming together of the human race. I’ve followed and embraced that spirit for a long time and definitely want to do right by them. This was a natural step in that larger effort. Western culture is very powerful.
FB: How far along was the planning?
A: The planning was a long process that went on for about 14 months. There were many levels of approval and clearance we had to go through on both the U.S. and Bahrainian sides. We just did what we were asked to do and completed all they requested with respect and cooperation. There were some background checks, but it seemed the State Dept. had already done a huge amount of research on me before hand. Most of the details were planned with my handlers and managers without my direct involvement. The plane tickets were booked for our trip to officially begin on December 1st, 2012. We coordinated the flights and travel details with the U.S. Embassy in Bahrain and left them completely in charge of all the on-location details.
A: We had our last planning phone call on Wednesday, November 21st, 2012. That’s when our State Dept. contact went over the final schedule and explained that I should officially announce the trip to the public. He explained what language to use and the overall tone of the trip and the ideals we would be promoting. I never actually met anyone in person from the State Dept. Everything was done either on the telephone or the computer. In 2003, I had been given a private tour of the White House by an ex-Secret Service official who was very passionate about my work and music. It’s possible that he was the one of the folks that first helped introduce the State Dept. to my work as a motivational speaker. Otherwise, I don’t know how they picked me specifically. That’s been really perplexing, but I didn’t think about it too much at first. I was just so excited to be asked. But once they canceled everything, I obviously have been trying to figure out what this whole thing is really about.
FB: Did State set up an itinerary?
A: Yes. We were sent the official itinerary by the State Dept. at approximately 6am on Monday, November 26th, 2012. The plans for the trip had always been based around lectures and motivational speeches at local schools. There was never a public concert planned, although we had plans to “jam” with some of the local musicians in Bahrain at a rehearsal space and music store. The main bulk of the trip was to be spent focused on positive interactions with the young people of Manama, the capital city. I planned on talking about positive thinking, making the most of one’s life, embracing freedom, and using partying to help forget your troubles. The State Department gave me overall guidelines, but were also very open to allowing me creative control when it came to how I would present our ideals and how I would present myself. They were always very familiar with what I do – that’s why they came to us in the first place – and they were certainly made even more familiar with me during the lengthy year-plus process of planning and clearance.
At about 11am on the same day we were sent the official itinerary, our State Department contact called us in a panic with the news that his “higher ups” canceled the entire trip for unknown reasons. Apparently it went far up the chain and a lot of people were getting in trouble, even to the point of being fired over this project.
A: It was explained to me that there was a passionate rock and metal scene in Bahrain. I had heard similar reports from others about there being lots of loud music fans in the more liberal parts of the Middle East. I was planning on playing some drums and keyboard and just making up songs or playing songs that we all could learn together. It was all very open to spontaneity. However, the State Dept. also made it very clear that the musical parts of the trip were secondary to the speaking engagements. It was always explained to me that the main goal was for me to help foster a positive impression of the U.S. in the minds of students and the people of Bahrain at large.
FB: How did it all start to fall apart? What happened?
A: It all happened very fast. Everything was good to go up until that Monday morning, after we received the itinerary. In that window of time between 6am and 12 noon, something happened and it has still yet to be explained what exactly it was, beyond that “higher up” State Dept. officials had changed their mind and now decided I was not an appropriate person to represent the U.S. as a Cultural Ambassador. It’s still not clear why they had this change of heart at the last second after they had invited me and spent a year carefully planning my trip. We had flights booked and the trip was less than a week away.
Some have said it was canceled because we announced the trip to the public, but I was encouraged to announce the trip by the State Dept. directly. The whole idea of my Cultural Ambassadorship was to generate public interest and excitement about the meeting of our two cultures. It was never meant to be a secret event – that would have defeated the entire point.
In the days since the cancellation, I’ve received inside tips that there was a passionate debate in the State Dept. about my going at the last second. It’s possible that someone outside of the State Dept. who wasn’t aware of the trip initially became incensed that they weren’t informed before. Apparently some of these unknown higher-up officials were on my side and others were deeply offended by the idea of me going. It would still be nice to learn exactly what happened and who specifically pulled the plug. I’m not taking it personally. For all I know, they could be protecting my own safety. Maybe there were threats, related or unrelated to the trip. It’s definitely confusing and kind of feels like a dream – like there was some other aspects to this project that maybe we didn’t understand or weren’t told about. I’m still as much in the dark as anyone.
FB: Bahrain is a pretty troubled place right now. I’m surprised that State was willing to send anyone over there. Did you have any reservations about going? We know from your live shows that you aren’t concerned about personal safety, of course. It could be suggested that the US would be supporting a repressive state, which some people might have trouble with. Was this ever in the conversation?
A: In the months leading up to the trip, I’ve learned a lot more about the complicated situation in Bahrain. I was definitely looking forward to getting an in-person view of what’s been going on and get a clearer impression of their land and their issues. Since I was going there to spread positivity on behalf of the U.S., it’s definitely been interesting and also concerning that I may have been used as some sort of pawn in a larger game to distract from the potentially bad situations. My handlers insisted that I would be safe and that the U.S. and Bahrain had a good relationship. I was going in the name of supporting that relationship and was expected to support a positive view of both countries.
Some of what’s been most confusing about this is wondering how it’s connected to earlier projects we’ve been a part of, and if I was chosen for reasons that aren’t as obvious, or weren’t openly explained to me. Kim Kardashian had been scheduled to visit Bahrain the same weekend we were there. She wasn’t formally sent by the U.S., but she was there to promote an American milkshake company. Apparently there were protests to her visit and some controversy in advance to her arrival. Some have speculated that maybe the State Dept. canceled my official Ambassador trip because it coincided with her unofficial visit. Of course, she has every right to visit with or without government sponsorship on our side, but it would be unusual to think of the State Dept. not wanting me to be there at the same time as her.
A: In the past week, we’ve received an incredible outpouring of support, especially from folks in Bahrain and the Middle East that had been looking forward to this trip. It’s been really moving and has definitely motivated us to find a way to go there with or without the support of my own country. We’re working on it. I’ve never been to the Middle East and really want to go.
FB: I could only find information on one other Cultural Ambassador, and that was Kareem Abdul Jabbar. How does it feel to almost have been in a club with the famous star of the seminal cinematic work, “Airplane“?
A: Kareem Abdul Jabbar is amazing and I’ve always loved him – his basketball legacy, and his work as an entertainer are awesome examples of America at its best. It’s been a real privilege to even imagine sharing some sort of place with him and other ambassadors in the history of U.S. culture. It seems like these are opportunities for us to show the world what this country can offer and to help unite more people together in the spirit of freedom and a shared global purpose.
FB: It’s great to have talked to you again after so many years. Were you OK after Hurricane Sandy? Did you eat any sand?
A: It’s wonderful to talk with you too, Pete! We were OK during Sandy, thank you. I always eat a bit of sand every few days, just for the earthy taste and texture. I’ve loved dirt eating since I was about 6 years old. I strongly recommend people try it at least once in their life. Party Hard Forever and stay strong!
PARTY HARD FOREVER