I keep staring at this picture, which appeared on “Economist’s View” last March and wondering exactly what I’m supposed to learn from this, aside from the obvious fact that health care in the US is too expensive.
We have known that health care in the US is too expensive for a long while now. We are also pretty sure of the reasons why, none of which are easily solved.
But we shouldn’t assume that there is a causal relationship between health care expenditures and life expectancy. The message here seems to be that other countries increase their health budgets and their citizens live progressively longer, but for some reason it doesn’t work in the US. Well, I don’t think it works anywhere.
There’s no evidence to suggest that extra spending this year will increase life expectancy this year. If anything, it is long past expenditures and improvements to health care that will increase life expectancy today. I think that if we looked at overall economic growth and life expectancy, we would see the same trend. Most of us will live longer, because we were born under better conditions than our grandparents, not because of government spending for health care, the vast majority of which goes to the elderly.
What this tells us, though, is two things: one, that health care in the US costs too much and seems to be increasing without bound (math talk). Second, that life expectancy in the US is shorter than these other countries. This is true, but the US is a fundamentally different place than any of the countries on that list, some of which has to do with social problems (racism) and some of which likely has to do with the fact that we take in larger numbers of immigrants from countries which have low life expectancies than any country on that list. These places aren’t comparable. While solving the problem of racism is noble, I don’t think that many people (except our President and his bigoted minions) want to suggest that we increase US life expectancy by deporting immigrants or closing the door to people from, say, Africa.
But we should be careful not to take home the message that there is an intrinsic relationship between spending and lifespan because that would be just misleading in my opinion.
Currently, I’m doing a research project on snakebites and found this gem in the literature, of which there is little:
“Snake bites are common in many regions of the world. Snake envenomation is relatively uncommon in Egypt; such unfortunate events usually attract much publicity. Snake bite is almost only accidental, occurring in urban areas and desert. Few cases were reported to commit suicide by snake. Homicidal snake poisoning is so rare. It was known in ancient world by executing capital punishment by throwing the victim into a pit full of snakes. Another way was to ask the victim to put his hand inside a small basket harboring a deadly snake. Killing a victim by direct snake bite is so rare. There was one reported case where an old couple was killed by snake bite. Here is the first reported case of killing three children by snake bite. It appeared that the diagnosis of such cases is so difficult and depended mainly on the circumstantial evidences.”
When does a person “ask” someone to “put his hand inside a small basket harboring a deadly snake?” Does that ever happen? Apparently so.
Apparently a man killed his three children using a snake.
It gets better:
“In deep police office investigations, it was found that the father disliked these three children as they were girls. He married another woman and had a male baby. The father decided to get rid of his girl children. To achieve his plan, he trained to become snake charmer and bought a snake (Egyptian cobra). The father forced the snake to bite the three children several times and left them to die. At last, he burned the snake.”
Paulis, M. G. and Faheem, A. L. (2016), Homicidal Snake Bite in Children. J Forensic Sci, 61: 559–561. doi:10.1111/1556-4029.12997
Humans have had to deal with the threat of snakebites as long as humans have existed. While deaths from snakebites are rare, the outcomes are so severe and the nature of the animal so mysterious, that humans have developed all sorts of ways of dealing with them.
Witchdoctors, or Mganga as they are known in East Africa, are the first line for snakebite treatment here. The Waganga are fairly useless for treating many serious health issues, but they have carved out a niche for themselves for a few public health problems.
Our survey in Western Kenya confirms that nearly 100% of people who have been bitten by a snake visit the Mganga, regardless of whether they visit a formal health facility or not.
I went and sat down with an established Mganga here in Kwale and he was gracious enough to answer all of my questions openly and (mostly) honestly.
Hello, thank you for taking the time to speak with me today. Is English OK?
No, my English is not very good. Can we do this through a translator?
Of course. So, what happens when a patient comes in for treatment for a snakebite?
When the patient comes in, I first apply the “njiwe na njoka” (lit: snake stone). The stone sucks all the poison out of the wound. When you put it on the bite, it will stick. When the stone has absorbed all the poison, it will fall off.
What do you mean? Like it just sticks to the flesh without tying it?
Yes, if there is poison, the stone will stick to the body. When all the poison is gone, the stone will fall off. After it is done, I take the stone and wash it with milk several times and then use it again for the next patient.
What is the snake stone? Is it like a rock? I’ve seen people use charcoal in the villages. They tie it to the wound, it doesn’t appear to stick on its own.
No, this is different. This is a stone from the snake. The stone is in the skull of the snake, like that of a fish.
(Note: I did not know this, but some species of snakes have otoliths, like most fish. Snakes (and fish) are deaf in the traditional sense. The otolith is a piece of calcium which grows as the animal ages and sit on top of a bed of nerves. When there are vibrations, the otolith vibrates, stimulating the nerve bed so that the animal can “hear” motion around it. Not all snakes have otoliths but some species of burrowing snakes do.)
Where do you get the stone? Can you just buy it in the market?
The snake stones come from the Maasai, from big snakes in Maasai land. My teacher travels to Maasai land to get them and brings them back.
If the wound is fresh, I apply the stone. However, if it has been two or three days since the bite, I can’t use the stone anymore. Then I have to use a special medicine made from herbs and crushed snake heads. I mix it all together, then crush it into a powder and keep in a gourd.
When the patient comes in, I use a new razor blade to make small scratches on the wound. Then I rub the powder in it and bandage the wound. The wound will try to heal over time, so you have to make the scratches to be able to apply the powder.
Do you use the razor blade again?
No, I always use a new blade. (He was emphatic on this point.)
What is the powder made from?
Snakeheads. When we kill a snake, we keep the heads to make the powder. We mix it with roots, bark and leaves from special plants from deep in the forest. My teacher is a security guard in one of the forests and can get them when he can find them.
Wait, so your teacher is a forest ranger? Can’t he get by being an Mganga?
Yes. He is a forest ranger.
So he took the job so that he can get the plants from the forest whenever he needs them.
OK, so how many bites do you see per month?
It depends, some months I get more than others but mostly one every three months or so.
Do you refer them to the health facility for formal treatment?
Yes, I do. I treat them, then they go to the facility, then they come back to me. (I’m suspicious on this point, though the Mganga in question appears more together than most.)
Is there a religious component to this?
Well, there are two kinds of bites, those where the snake just bites and there is no witchcraft and those where someone has used magic to send the snake to bite you.
How do you know the difference?
If the bite heals quickly, there is no witchcraft. But if the bite is treated and does not improve then there is definitely witchcraft involved. At that time, I have to use powerful magic to get rid of the curse.
What do you do?
I send the snake back to the person who applied the curse. When we hear that someone nearby has been bitten, we know who applied the curse.
(Note: this is not uncommon. Witchcraft is often associated with hatred and revenge but the person applying the curse risks becoming cursed themselves. It is possible that snakebites are seen as a never ending battle of malevolent spiritual forces. What this does is sow distrust among people, even families and the Mganga is seen as the only cure. The result is that the Mganga are never without work.)
How did you learn this craft?
I was sick for a long time with stomach and head problems. I went to the hospital and it never got better so then I went to an Mganga. I improved. The Mganga suggested that I become on and I started training under him.
Thank you very much for your time.
I made this trip out to the coast, first to do some damn work and second because I can get out of Nairobi and be spared spending Nairobi money for a while. A week’s worth of not-Nairobi-money is money in the bank. In Nairobi, you simply walk outside and 1000 schilling notes start flying away.
Some things I noticed (I’ll get to the snakes in a minute):
- It’s damn hot out here. Nairobi is cold. Here, it’s like being immersed in a sauna continuously, except for the hours of 3 to 5 am, which become cold for some reason.
- Fish from the sea is good. There are ample stocks of mackerel out here. I always want to make 塩サバ and have a side of okra. Or ゴーヤ. Or 山芋. Or something.
- Somalis are cool dudes. As in, they want to do business, they want to make sure you are happy and that you come back again. Kenyan business people are really just interested in getting your money right then probably because they might be out of business tomorrow. They don’t care if you come back. But then, if you don’t keep customers, you will go out of business. Welcome to the world of business in Kenya.
- Somalis make somali coffee, as in, not Nescafe. They put coffee grounds in hot water and steam the shit out of it. It’s refreshing. Though I noticed that they were pulling water from a plastic jerry can on the floor. One has to wonder where the water comes from.
- As much as possible, avoid the tomatoes and onions they put on the pilau (a dish like 混ぜご飯.) Yesterday, as I was eating my pilau, I ate the tomatoes and onions. I knew that things would turn out badly. Imodium is my friend right now.
- Mombasa is a weird place. I always expect to see people with dancing monkeys or snake charmers on the street, but then you look closer and it really is Kenya. They really tried to make a nice city at one point, but the city services never caught up. Trash is a constant problem. But there’s this weird mix of Arab, Brit and Indian architecture. It truly is an international city. They also like perfume. And they love ice cream. I think because they don’t drink and smoke, they can actually smell and taste things.
- Tarbousch: I always used to get the Biryani there, but the waiter convinced me to try the chicken schwarma. Perhaps the best shwarma I’ve ever had. I ordered two in the end.
- Police: Are stupid. Like really dumb. My tuk tuk driver failed to stop for the police, likely because he couldn’t here them over the cacophony of tuktuk motors everywhere. I apologized to the policemen to be friendly. He tried to arrest me for the tuk tuk driver’s failure to stop. The policeman was obviously a complete moron. I had to start fake calling the Kenyan Ministry of Health to “report him.” Eventually he let me go. I hate those guys. Likely, he wanted money.
- Mombasa is remarkably music free. Given Somalia’s rich musical history and the ubiquity of Taraab music in Zanzibar, you would assume the Mombasa might have some kind of musical culture, but it does not. Plenty of people seem to buy stereos and the matatus blast out Bongo (TZ) music, but there’s a stunning lack of performance culture of any kind here. Again, I blame Moi.
- Living in Nairobi will make you really mean. You just stop being nice to people you don’t know. It’s a cancer really.