I was just reading a comment in the new Journal of the American Society of Tropical Medicine and Hygiene “After Malaria is controlled, what next?”
Fortunately for all of our jobs, there is little to worry about. Malaria, as a complex environmental/political/economic public health problem, won’t be controlled anytime soon. As there’s no indication that many sub-Saharan countries will effectively ameliorate their political problems and also no sign that, despite the “Rising Africa” narrative, African countries will develop in such a way that economic rewards will trickle down to the poorest of the poor, malaria transmission will continue unabated. This is a horribly unfortunate outcome for the people, particularly small children, who have to live with malaria in their daily lives.
In all of the places it occurs, malaria is merely a symptom of a greater political and economic failure.
Indeed, we really know less about the causes of suffering and death in the tropics than many believe. Even vital statistics of birth and death are unrecorded in many areas of the world, much less the accurate causes of disease and death. Some diagnoses, such as malaria, dengue fever, and typhoid fever, are often ascribed to patients’ illnesses without laboratory confirmation. Under the shadow of the umbrella of these diagnoses, other diseases are lurking. I have found significant incidences of spotted fever and typhus group rickettsioses and ehrlichiosis among series of diagnostic samples of patients suspected to have malaria, typhoid, and dengue in tropical geographic locations, where these rickettsial and ehrlichial diseases were previously not even considered by physicians to exist.4–8 Control of malaria or dengue would reveal the presence and magnitude of other currently hidden diseases and stimulate studies to identify the etiologic agents.
This is the problem with our public health fascination with malaria. We are missing all of the other pathogens and conditions which case untold suffering in the poorest and most isolated communities. It can’t be the case that malaria acts in a box. In fact, it could be the case, that multiple pathogens coordinate their efforts to extract as many human biological and behavioral resources as possible to obtain maximum opportunities for reproduction and sustenance. A public health system only designed to look for and treat a limited window of diseases misses the opportunity to disrupt what is probably a vast ecological complex.
First, we have a problem of poor diagnostics. Facilities traditionally treat most fevers presumptively as malaria, dispensing drugs appropriate to that condition. However, conditions like dengue fever exhibit similar symptoms. While is it extremely likely that dengue is all over the African continent, particularly in urban areas, there is little ability to identify true dengue cases in the public health sector, and thus, in addition to mistreating patients, the extent of the disease burden is unknown. We cannot tackle large public health issues without proper data.
Second, we have the problem of all of the “known unknowns,” that is, we know for a fact that there’s more out there than we have data for but we also know (or at least I do) that there is a greater disease ecology out there. We know that many pathogens interact with one another for their mutual advantage or to haplessly effect significantly worse outcomes. The awful synergy of HIV and TB is just one example.
OK, I’m going to go and deal with my own pathogenic tenant which I think I’ve identified as an enteric pathogen of the genus Pseudomonas, which might have taken hold opportunistically through an influenza infection. This is complete speculation, however. Data quality issues prevent a reliable diagnosis!
I’m not stupid. I know that I’m much more likely to be hit by a car in Nairobi than to be killed in a terror attack, but I can at least minimize the risks of being hit by an automobile. Terror attacks, on the other hand, come from nowhere.
The Kenyatta administration has proven itself completely incapable of dealing with issues of security. It’s pathetic appropriation of the Mpeketoni attacks for petty domestic squabbles is at least as embarrassing as it is dangerous.
From Think Africa Press:
Initially, al-Shabaab claimed responsibility for Mpeketoni killings through a spokesperson, declaring that Kenya was now “officially a war zone.” However, in a speech to the nation the next day, Kenya’s President Uhuru Kenyatta dismissed the notion that the Islamist militants were behind the attack, maintaining instead that it was “politically motivated ethnic violence.”
Though he did not explicitly mention names, local media outlets interpreted Kenyatta’s allegations as being aimed at the leader of the opposition, Raila Odinga. In response to these apparent accusations, Odinga in turn blamed the Kenyatta administration for failing to address the security situation since Westgate and called for the resignation of Joseph ole Lenku, Kenya’s Cabinet Secretary for the Ministry of Interior and Coordination of National Government.
Opposition leader Raila Odinga, a seasoned Luo politician affiliated with the Orange Democratic Party, has been rattling the cage for the past few months, demanding a “dialogue” with the Presidential office. Kenyatta, who ran on a platform of unity, appears uninterested in engaging the Luo stalwart.
If he doesn’t engage Raila, we’re guaranteed a day of demonstrations and inevitable rioting on July 7th, the day celebrating the birth (return to?) multipartyism in Kenya during Moi’s disastrous Presidency. It’s going to be a bloodbath, and Kenyatta will be watching in the safety of the State House. Most likely, though, he’ll be quietly watching football. Regular folks will be blaming this or that tribe for the fallout and we’ll slowly return to the bad old days of tribal violence.
Most troubling is Kenyatta’s refusal to engage the West, instead trying to curry short-term favors from China. A new road to allow Kenyan elites to move around the outskirts of Nairobi is worth more than solid security assistance from the West. Even more troubling is the seeming lack of interest from the Obama admin to a spreading terror threat in East Africa. Recruitment among Kenyans has become even easier given Kenya’s growing political divide, providing a ripe breeding ground for violence which could spread far beyond Kenya’s borders and potentially destabilize the most important economy in East Africa.
From Think Africa Press:
A domestic threat
So far this year, there have been 14 attacks in Nairobi, Mombasa and the nearby coastal tourist area, according to data from Terrorism Tracker. By contrast, there were just eight such incidents in these areas in the whole of 2013. This also marks a geographical shift in the threat, with attacks now being more common in Nairobi, Mombasa and the coast than in the northeastern region bordering Somalia. Although al-Shabaab continues to mount infrequent mass casualty operations inside Kenya, it seems to be Kenyan militant groups operating from Nairobi and Mombasa that now pose the greatest threat.
So the line between Al Shabab and local “militant groups,” the nature of which is mostly unknown, the credit for which goes to a policy of non-communication from the Kenyan Government itself. The Americans are quite good at identifying the nature of the threats, though also quite adept at defining it thereby giving militant groups an opportunity to mold their images in the shape of how the West perceives it. Here, that opportunity doesn’t exist. On the surface, this seems like a destabilizing strategy for militant groups, but in reality, it merely exacerbates the threat by giving it no ideological boundaries to operate in. The violence becomes random, and hobbles the ability to politically engage these groups.
These days, I’m pretty sensitive to the idea of Islamic militants, given that Al-Shabab seems to be successfully killing people not a stones throw from where I live and work. Honestly, as much as it pains me to say, I’d be more than happy to see some American humvees rolling into Kenya’s coast right now since the Kenyan government seems pretty useless when it comes to issues of security.
ISIS’s crusade, however, lies far from here, though ISIS’s successes could embolden Islamist groups elsewhere, though it’s difficult for me to gauge how deep the connections are between Islamist groups.
The video, however, was quite interesting. The first thing that strikes me is that the presenter is Chilean, speaking American English, representing the international nature of ISIS itself. It is not a home grown ethnic Islamist movement, struggling for historical territory and self-determination. Like it’s arch enemy Israel, it is an international movement of foreigners seeking to establish and ideological state in a foreign, based upon a self-created narrative of religious entitlement.
There are various scenes which show the host talking with other members of the group, who are clearly a hodge-podge of ethnicities and nationalities. The common language appears to be, in many cases, English, though at times it’s hard to tell.
The production values, outside of the sound, are excellent. Most striking is the use of symbols. Throughout the video, the host walks through a number of symbolic points, starting at the border of Iraq and Syria itself, to symbols of border checkpoints, military patches and signs. The message is that ISIS is exposing these symbols as empty illusions, positioning itself as the harbingers of Islam in a corrupt and empty landscape.
What’s interesting is that a young Chilean, likely raised in the US or Canada, is seen mocking much older and obviously local prisoners. He calls the Kurds Satan worshipers and mocks the Iraqi soldiers as cowards and fools.
So, how is ISIS, as an international terror group with roots in the West, any different from the corrupting Westerners they so hate? The video repeatedly appeals to Western sentiments that Sykes-Picot was the great destabilizing factor in the middle east, but it’s unclear as to how ISIS provides an avenue of self-determination to the ethnic groups who were broken up or forced to tolerate one another. Does taking the borders away liberate Sunnis and Shiites? Does ISIS respect the right of self-determination for Kurds? Clearly not.
Check out the video. It’s pretty surreal.
Spent the week in Kwale, a sleepy town on near the Mombasa coast. The security situation prevents me from spending a whole lot of time there. I find this to be incredibly saddening but its unavoidable. Some people brave it out and stick with it, but I just can’t justify the awful risks.
The Japanese folks are mostly oblivious to it all, or maybe just indifferent. I’m convinced that they have no real concept of threat, given the relative safety of Japan itself. It’s a horribly dangerous situation but fortunately they stay locked inside. Japanese people love to sit at desks, even when they don’t really have to. Japan has yet to appropriate the concept of the mobile office. (Sorry, generalizations abound….)
I’ve caught some infection, but it’s hard to say exactly what it is. At first, it looked a lot like malaria, but then everything looks like malaria. Now, I’m just in a general state of not feeling well. It’s not responding to antibiotics, which makes me suspect that it’s not bacterial in nature. I started a round of ACTs just in case. They leave me a bit loopy, but I’m improving somewhat. A malaria test turned out faintly negative, but it’s possible the antibiotics are skewing the result or that the guy doing the test spilled to much assay onto the test. So, I’m not sure. I have a somewhat better appreciation for why the tests are treated with suspicion by the locals.
In any case, I feel like total hell, but thankfully have a normal appetite and digestion. I deeply crave red meat though, which leads me to suspect that the dizziness is anemia and thus, the cause could be malaria. This might be wishful thinking though. I could simply be exhausted.
Kenyatta is universally hated on the Coast, which explains a lot of the violence here. Though people apt to disregard domestic politics when talking of terrorism here, it’s hard to rule it out given the vast resentment toward the Jubilee party here on the coast. In fact, the lack of attention to security by the Kenyatta administration is likely fueling even more resentment, which might be fueling even more violence or at least, helping improve recruiting numbers for Al Shabab. As crazy as I think Luo politics are, Raila Odinga would have made a far better president.
People here are convinced that Kenyatta is a weed-head. “He is smoking the mari-ju-a-na.”
I spent the last two days convalescing in a hotel located within the Shimba Hills Nature Reserve. As much as I wanted to tough out the guest house in Kwale (which really isn’t so bad at all), I really needed a decent few hours of rest in a somewhat pleasant environment. It was worth it. A real hot shower and a set of clean sheets is worth the extra cash every now and again. The only wildlife to be seen were bush babies and squirrels, who seem to have worked out a deal where one begs for food in the day, and the other at night.
Malaria transmission here is low and it shows. Malaria endemic areas are characterized by low levels of education, part of which may be attributable to the inhibited cognitive development of children due to repeated malaria infections. Even if educational opportunities are available, kids in malaria endemic areas appear to have worse outcomes. It’s somewhat staggering at times, after having worked in Western. Part of it also could be the influence of Islam.
I’m now flying back to Nairobi where I’ll crawl into my bed. If I’m lucky, I’ll not come out for a few days.
Was reading Chris Blattman’s list of books that development people should read but don’t and found this in the Amazon description of “The Anti-Politics Machine: Development, Depoliticization, and Bureaucratic Power in Lesotho.”
Development, it is generally assumed, is good and necessary, and in its name the West has intervened, implementing all manner of projects in the impoverished regions of the world. When these projects fail, as they do with astonishing regularity, they nonetheless produce a host of regular and unacknowledged effects, including the expansion of bureaucratic state power and the translation of the political realities of poverty and powerlessness into “technical” problems awaiting solution by “development” agencies and experts.
Note that I do not harbor any ill will toward development or even, as a general rule, “technical solutions.” Having been involved with bed net distributions and having watched the outcomes of reproductive health interventions, for example, I can say that there are many positive outcomes of development projects. In my area, fewer kids are dying and women are becoming pregnant a whole lot less, decreasing the risk of maternal mortality.
Disclaimers aside, there is no doubt that development projects often fail for a number of reasons, the first of which is that leaders have no interest in seeing that they succeed. While leaders are indifferent to the outcomes, they happily take on the power that comes with them, embracing bureaucratic reforms, which are mostly just expansions of power at all levels of government.
This wouldn’t necessarily be a bad thing, except that African countries never embraced many of the protections of individual rights which restrict the powers of the state. Independence movements in much of Africa was predicated on an eventual return of power to the majority. Not many (none?) of these movements sought to protect the rights of the minority, much less the individual. Thus, there is little restriction on the types of rules which may be created and since many of these development projects influence policy, development projects unwittingly feed into the autocracy machine.
I’ve been coming here for close to three years, and I’m struck at the rapidity of change here. There used to be only two ferry trips a day to Luanda Port, where you can catch a minibus to Kisumu, Nyanza’s largest city. Now, there’s not only multiple trips a day, but also two ferries, a small one and a large one.
You can also catch a ferry to neighboring Mfangano island, a small but heavily populated place which was formerly mostly isolated from the mainland.
The power still comes on and off, but blackouts are shorter and more infrequent. There are multiple places to see music now, a direct result of people having more money. Local and national acts are taking advantage of Mbita’s increased affluence.
Mirroring much of Kenya, though, construction of a few “high rise” buildings has been completed, but it’s kind of unclear as to who is going to move in. “Mbita Towers” is mostly empty.
People look better, the cars are in better shape, there are more buses going to Kisumu and Nairobi and there is a larger variety of foods and goods available at the local market. This is due in part to the semi-completion of a road connecting nearby Homa Bay to Mbita. There are still a few rough spots between, but it’s mostly passable now. Someone told me that just four years ago it took two days to get from Nairobi to here, despite there being only 400 km between them.
No doubt, this isn’t due to the good graces of any particular development project at all, but rather to the increased affluence of Kenya as a whole. Kenyatta’s government would inexplicably love to credit the Chinese, and they should be credited for constructing some of the road infrastructure, but the real credit has to be given to the development of the domestic economy and Kenya’s status as the most liberal economy in the region.
Kenyans are increasingly not only connected with the world, but also to each other. Cell phones, for example, have allowed Kenyans greater mobility so that they can take advantage of money-making opportunities elsewhere, and mobile banking allows money to flow out of Nairobi, where it was traditionally concentrated.
Kenya still ranks low on “ease of doing business” indicators, and continues to be excessively bureaucratic. New rules seem to appear each day, the goals of which are often unclear and seem to be aimed only at corrupt officials on every level of government. A recent ban on tinted windows, supposedly aimed at terrorism, and an onerous highway speed limit of 80 km/h for small trucks, billed as reducing traffic fatalities, are providing a steady source of cash for hungry highway policemen. It’s worth noting that the latter rule doesn’t apply to SUV’s, the vehicle of choice for Kenya’s elite.
Fortunately, many people simply ignore the government and carry on like it doesn’t exist. This is particularly true out here. My taxi driver completely ignored the speed rules and sped on at 120 km/h. Of course, there’s not a policeman to be seen anywhere out here outside of the the local bar at 3 p.m. The relative peace out here makes them mostly unnecessary, anyway.
This question has been bothering me for a while. While it’s obvious that Godzilla would only visit Japan and the US given that the US and Japan are the only countries which make Godzilla movies, I’ve long been puzzled as to why Godzilla would visit those two exclusively. Specifically, why doesn’t Godzilla visit poor countries? (Note: I realize that Godzilla is a good guy, but ask readers to remember that he didn’t start out that way)
Certainly, the environmental devastation in poor countries is as extensive as in wealthy countries (and perhaps moreso, given the lack of financial and political resources to measure it, let alone do anything about it), making Tanzania, for example, just as much a candidate for kaiju destruction as any other.
But what would happen? First, were Godzilla appear on the shores of the coast of Kenya, he’d (is it male?) have to plow through the port of Mombasa. Godzilla may be destructive, but he’s known to follow standard immigration procedures. He’d meet little resistance, given Kenya’s lax border protection. At the worst, he’d be asked to pay $50 to stay for three months.
Mombasa isn’t a big town, so he’d be over the island and into the country in a matter a seconds, though he might consider a pleasant break on the beach. After finally eradicating Kenya’s terror problem and quashing any ideas of Mombasan separatism, he’d stroll to the Mombasa highway and lumber up to Nairobi, where the real action could start.
In contrast to Japan and the US, Godzilla would find the response by the local military to be tepid at best. A few planes might buzz around aimlessly and a couple of tanks might lob some rounds at his legs, but the military, lacking any incentive to loot cell phones or liquor would probably simply slink away in short order. Response from the African Union or the UN would be slow coming, as they’d have to wait to see if the media reacted with sufficient outrage to warrant action. The US would most certainly refuse to be involved in anything other than a support role.
Godzilla would plod through Nairobi and lay waste to the City Centre in a matter of seconds. It would be like a child stepping through a grandmothers flower garden. He’d probably quickly become bored, lacking much to topple over outside of a few unfinished apartment buildings and maybe a mall here and there. If he were after human destruction, he might take a few steps through Kibera, where he’d certainly kill a half a million people in the space of a single Godzilla breath.
After an anti-climactic fight in Nairobi, he’d have to take a break in Karen to consider what to do next. Maybe he’d move on to Kampala? Or regret his decision and move back to India? It’s hard to say.
The human costs would be incredible. A couple of million people would likely die immediately, the majority of which would be poor given the incredible density in slums like Kibera and their inability to properly evacuate from the city. The sleep inducing traffic jams are unavoidable even under normal circumstances. A manic run for the countryside by all of Nairobi would only make things worse but squatter settlements and slums would reappear within days.
In the long term, however, Godzilla’s destruction of Kenya might pay off. Massive amounts of funding would appear from a number of international sources to rebuild Nairobi’s devastated infrastructure. The Chinese would appear and immediately start rebuilding the highway system from scratch using cheap imported labor. The Americans would set about reconstructing Kenya’s likely devastated military and ports. The British would dump money into overhauling Nairobi’s failing sanitation system, long due for replacement. Kenya would get an infrastructural reboot.
On the other hand, real estate speculators would flow in like flies on roadkill, hoping for a payoff once Kenya’s economy got back on track. Where real estate prices would have crashed immediately following the destruction of Nairobi, leading to a cheap scramble for land, the current real estate boom soon again be underway. Domestic investors would now have even less incentive to develop Kenya’s manufacturing sector and the economy would hobble along as it did before.
Given the political chaos following Godzilla’s destruction of the central government, Chinese investors would grab as much agricultural land as possible, citing “gifts” of highways and football stadiums further entrenching China’s increasingly overbearing presence in the country.
In essence, Kenya, as independent state, would cease to exist.
It might be the case, however, that the destruction of Kenya’s cities might finally sway the Kenyan citizenry away from tribal politics and toward a truly democratic state. People can, and do, often surprise us, but this would be a hard, hard road given that most of the reconstruction would not be democratically determined, but rather orchestrated by World Bank and UN technocrats and Chinese land grabs. It’s clear that Kenya’s self interested leaders would do nothing to stop it.
So, conclusion? Kenya would win big in improved infrastructure, but lose big given the resultant political weakness. In the long term, Kenya might regain some of it’s political footing given improvements in the domestic economy, but it would take decades and a lot of political will to make this happen.
These words are mostly regional and the uses and nuances of calling people stupid also vary by place.
Over dinner, I was reminded of an episode of Tante Night Scoop, an investigative television program which ran throughout the 90′s. They did an exhaustive survey and mapped the locations of the common ways of calling people stupid throughout Japan.
Of interest is the centrality of the word “aho,” commonly used throughout the Kansai region of Japan (and denoted in red) and the radial spread of “baka” (denoted in blue), a word mostly associated with Tokyo and commonly found in Kanto-centric anime programs.
The map was intended as entertainment, but it has serious historical significance.
When people move, they take words with them. It would appear that people in Kansai, historically the political and economic center of Japan, had little reason to leave the region, which would explain “aho”‘s limited spread. Baka, however, can be found on both sides of Kanto, indicating that there were strong connections between the two sides, despite the distance between them.
Oddly, the other words for “stupid” occupy the same radii from Kansai indicating that certain groups of people had peculiar spatial advantages in trade, where as others did not. Though I really have no idea, I’m thinking that particular perishable products traded with Kansai might have different spoiling times necessitating particular proximities. It’s important also to note that the extreme peripheries might have been trading non-perishable resources like coal, which, though heavy, doesn’t rot.
Economics, trade and language have deep links. English wouldn’t exist without it, and the many forms of English spoken throughout the world have been influenced by the multitude of groups of people who chose to speak it to facilitate trade.
OK, enough for now and back to Kenya.
Over the course of the day it went from white to brown to red to black. I’m thanking Columbia clothing that the rest of my isn’t black as well.
It sounds really trivial; I got a sunburn. But I’m a really pale guy, and there’s a reason for that. The bulk of my genetics come from northern Europe, an area which is mostly dark, and even when it’s not dark, the sun is filtered through a thick wall of air and moisture.
My skin is not suited to Kenya’s blistering sunlight. My Japanese colleagues inexplicably do their best to keep themselves from tanning. Honestly, I’m jealous of their ability to brown in the sun and don’t really understand why they don’t take full advantage of their innate ability to protect themselves.
In short, I was born pale white, but wish I were black or at least able to brown. It would make field work easier.
Which brings me to this. I often hear people engaging in common conversations about what humans “were meant to do,” as if we were created as complete biological entities designed to perfectly perform specific assigned tasks within the narrow confines of specific environments.
This is a creationist view, but it’s interesting that even non-Christians in the West readily use the same assumptions and terms that are common to religious fundamentalists. The idea is that everything that came after we were kicked out of Eden, in this case East Africa, the birthplace of humanity, is an abomination. Whatever health or social problems we suffer is payback for violating the terms of our initially assigned roles as living beings.
For example, arguments (incorrect ones, by the way) are often made that humans are “meant to be” vegetarians since we don’t have developed canines, an argument of course made preposterous when one runs through the list of mammalian omnivores which also do not have canines. Worse yet, the argument fails to recognize one of humanities greatest adaptations, which is that we can eat just about anything and survive on little for extended periods of time, a skill that allowed us to rapidly move out of East Africa into every corner of the globe.
More salient, however, is that humans were not “meant to be” anything. Like all living beings, we move in response to environment pressures and then adapt while suffering the devastating loss of infants who will not live to pass on traits unsuited to the current environment. Those babies better suited to make it to reproductive age pass on whatever it is that got them there to their children, who then pass it on to their own and mix with others in a sort of genetic democracy.
Babies of my ancestors in northern Europe were more likely to survive with lighter skin, while light skinned babies in Kenya were more likely to not. Neither is “better” than another, but both are suited to their respective environments as they are at that time and neither represent a terminus of genetics.
I take issue with a static view of the world, be it from fundamentalist Christians, who claim that humanity was created fully whole in God’s image or from well meaning secularists, who claim that the world was a biologically static place before the Egyptians, the Romans, the Europeans, the Capitalists and whoever else came in and fucked it all up. Really, it’s interesting how the Biblical creation story persists, even in secular debates.
In my own field, a great failing of research has been to ignore the dynamic nature or disease and human health, assuming that each cross sectionally measured point in time represents a final culmination of set of repeatable events akin to billiard balls on a table. Diseases aren’t that simple. They change in response to the challenges we present to them, which in turn feed back into our own behaviors.
I certainly don’t defend environmental degradation or would I ever minimize calls for developing more sustainable energy and food production systems. However, I would offer that the world, like human genetics is not static, but rather, incredibly dynamic and that a static (and somewhat falsely nostalgic) view of the world is destructive in itself because it keeps us from recognizing the challenges of the present day. Only by thoughtfully examining current conditions and recognizing that things can change can we develop solutions to present and potential future problems.
Alright, I’m done.