Archive | January 26, 2014

I’m really not sure what purpose this book serves. While I don’t want to beat up on it too badly, fearing that if I ever get around to writing a book someone will mercilessly eviscerate mine, I can’t say that I really understand what “Stringer” says that the numerous other books on the Congo haven’t.

Anjan Sundaram was a PhD student in math under the great algebraist Serge Lang at Yale. One day, in an inexplicable moment of odd judgement, Sundaram decides to abandon what one would assume it to be a promising academic career to become a journalist. He befriends a lady at the bank who offers to contact her family in the Kinshasa and set him up with a place to stay.

Sundaram doesn’t like the DRC. In fact, it’s hard to tell whether he likes anyone at all. It’s hard to understand why he’s there and his lack of street smarts and simple human compassion quickly grate on the nerves. Half the book are scenes of him getting ripped off, even by his own host family and him not seeming to understand why.

His writing views the Congo through a lens of disdain, fear and condescension, echoing nearly a century of writing on the Congo. This may be by design. It’s hard to divorce oneself from Conrad when writing on the Congo (but not impossible). Regardless, though he claims to make pains to reveal the positive side of being a street kid, a group of whom he seems to form the deepest connections, the scenes are so fleeting as to relegate an otherwise potentially interesting subject to be mere window dressing.

He has odd realizations throughout the book, apparently surprised that rural Congolese are capable, hardworking people:

On the periphery of that village area I met a woman with a child on her back. Bending over, she was tilling someone else’s field. She said she worked from 6 :00 a.m . until 8: 00 p.m.— a fourteen-hour workday. But she earned only enough to eat the leaves of beans. Her hut was tiny and dark. A white rabbit cowered in the corner. She squatted inside , waiting for the leaves to boil. This woman struck me as something new in the world. She did not fall into any obvious category of African destitution: she was not a refugee or diseased or the victim of rape or violence. She was willing to work. It seemed to me that by any system of distribution of wealth— communist, socialist , capitalist— she had no reason to be poor.

Good God. I was constantly struck by Sundaram’s ignorance of developing countries, given that he’s from one.

Sundaram, Anjan (2014-01-07). Stringer: A Reporter’s Journey in the Congo (p. 160). Knopf Doubleday Publishing Group. Kindle Edition.

The press on this book is incredible. I saw Sundaram on the Daily Show the other day and thought that, given the rarity of having such publicity fawned on a book about Africa, it must be distinctly interesting. My assumptions were incorrect. “Stringer: A Reporter’s Journey in the Congo” while flying up the best seller charts offers nothing new. I get why people want to read books like “Stringer,” as it offers a window into a place that most can never go, written in a language they can understand. But it is troubling is that light fare from slumming academics would receive so much praise, while African literary artists continue to be ignored.

Sundaram’s prose is quite good. I only wish he had taken the time to do something more insightful with the book.

January 26, 2014

in Africa, Development, Economics, Health, Human Rights, Malaria, pharmaceuticals, Policy, Politics
1 Comment

Malaria eradication makes the Economist

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.