- The Return of Yellow Fever (link)
- Historical Review: Problematic Malaria Prophylaxis with Quinine (link)
- A Single-Payer Plan From Bernie Sanders Would Probably Still Be Expensive (link)
- A Unique Perspective on the Making of ‘STALKER’: The Testimony of a Mechanic Toiling Away Under Tarkovsky’s Guidance (link)
- Lethality of First Contact Dysentery Epidemics on Pacific Islands (link)
and some nyatiti from Luoland:
I was at a friend’s this weekend, who just happens to do video work (for an NGO in East Africa) and who just happened to have a friend from the UK doing video work (in a Somali refugee camp in Kenya) and who both just happened to want to shoot a video, which went from shooting a simple practice video of our band (more on that later) to “Pete, let’s film you doing a couple of solo songs” which turned into 2.5 hours of intense setup (six cameras) and 10 minutes of filming. And hours of editing. And uploading.
The results were great and I’m incredibly thankful to Colin Crowley and Niko Belev for making me look better than I really do. Thank, dudes.
I recently went and saw the latest installment of Marvel’s film series, “Captain America: Civil War” and was reminded of Black Panther, Marvel’s other African hero (X-Men’s Storm would be the other). Black Panther is a prince of Wakanda, a fictional African country, which just so happens to be located near Lake Turkana, close to the Sundanese and Kenyan borders. Apparently, I could go and visit Wakanda if I wanted.
Wakanda is a special, though reclusive place. Wakanda is the world’s only source of Vibranium, the metal from which Captain America’s shield was created. Wakandans, though historically hunter gatherers, profited from the sale of Vibranium, and became one of the richest countries on earth. The prince of Wakanda, in contrast to many of his peers, reinvested the money in technological development ventures, and allowed his people to flourish. Wakanda’s tech is like nowhere else on Earth, designed specifically by Wakandans for Wakandans. In short, Wakanda is what Kagame wishes Rwanda could be.
I had no idea that Black Panther was slated to appear in “Civil War” and was happy they chose to film in Lagos rather than in some stereotypical African landscape of lions and elephants. People on this side of the world are excited about the prospect of a Black Panther stand alone film, due in 2018. Africa needs heroes, particularly ones who can stand on equal footing with heroes from everywhere else.
A fan made trailer, but…
Looking at some data on socio-economic status (SES) from two regions of Kenya, I was able to compare current levels of household wealth with those of 2007 in the same households.
We measured SES using a method common to studies of developing countries. An accounting of specific material goods including ownership of radios, TVs and bikes along with type of water source, toilet is performed. We then use multiple correspondence analysis to assign weights to each item as they appear in the data set and a total score is calculated for each household (Filmer and Pritchett, 2001 though they use PCA). Each score (ideally) represents the relative level of wealth of each household.
Kenya’s GDP has been increasing rapidly since 2001. During my five years of travelling to this country, I’ve seen the place transform itself. There are more goods on the shelves, people look better, kids die less and women have fewer children. HIV and malaria are down and people are busier. It’s worth noting that Kenya has no real natural resources; its economy is mostly based on a well developed domestic market economy and agricultural exports.
The question, however, is whether these economic gains are being felt by everyone equally. To test this, I compared data from 2007 and 2015 to see if all households experienced an increase in wealth during this period.
I made the graph above. Assuming I’m interpreting the graph correctly, this would suggest that while wealthier households in 2007 consistently continue to be wealthy in 2015, the relationship for poor households is scattered. Some households are doing better, while other may have experience no change, while others may be poorer in 2015.
Clearly, no matter how one interprets these results, we should be explore what types of households might be falling behind, or experience no gains at all.
I looked at the Sustainable Development Goals for fun last week, became blinded by their Biblical length and decided that I’d revisit them when my sight returned. I still can’t really see, but managed to get through them anyway.
The SDGs are a replacement for the now-expired Millennium Development Goals (MDGs), a set of benchmarks that serve as a guide for the development trajectories of developing countries. The MDGs were widely criticized for lacking proper justification and for not providing proper means to measure the items suggested.
The items range from standard development goals such as “elimination of poverty” to far more complicated items such as number 12:
Rationalize inefficient fossil-fuel subsidies that encourage wasteful consumption by removing market distortions, in accordance with national circumstances, including by restructuring taxation and phasing out those harmful subsidies, where they exist, to reflect their environmental impacts, taking fully into account the specific needs and conditions of developing countries and minimizing the possible adverse impacts on their development in a manner that protects the poor and the affected communities.
Good god. It’s like the SDGs went out of their way to create titles for every development proposal for the next ten years so people wouldn’t have to. Unfortunately, this particular proposal will be incomprehensible to the common person. It is ironic that item 17.14 is “Enhance policy coherence for sustainable development.”
Living in Africa, it’s pretty easy to get cynical about international development projects. One of the effects of the SDGs, however, will be to stifle craetivity by being too specific. It is a reality that a lot of NGO work is redundant or ineffective, but the MDGs were at least broad enough to allow locals to come up with ideas to address them on their own that took local conditions into account. I’m not sure the the SDGs will allow that level of freedom.
I’m going to end this short post with Kurt Schwitters. It seems appropriate.
Why malaria? Over-researched, over-funded, diminishing returns? Rambling on the need for student mentorship.
Last week I gave an informal lecture on survey sampling to a small group of graduate students from a number of countries. With only one exception, all of the students were working on various aspects of malaria, primarily in basic sciences. The lone non-malaria student was from Vietnam and is interested in Dengue fever.
I praised her for working on Dengue. Dengue presents a serious threat to human health in all countries where the vectors exist, but the burden of disease will be particularly felt in rapidly urbanizing areas of developing countries.
Developing countries are ill equipped to deal with Dengue, and the antiquated nature of their health care systems, leftover by the colonialists, means that diagnostics are mostly non-existent and drugs wholly unavailable. Any fever in most of Sub-Saharan Africa is diagnosed simply as malaria, drugs administered and the patient left on their own.
We have extensive experience, however, with malaria. While there are numerous challenges to reducing malaria incidence, preventing recrudescence and postponing drug resistance, the basic fact is that the best way to eliminate or control malaria is to simply make people less poor. Even countries with holoendemic transmission, wealthier people get malaria less often than poor people, and poor people who live in wealthier areas get sick less than wealthier people in poor areas. This is known (in Game of Thrones parlance).
So, as we discussed the topic during lecture, I softly tried to encourage the students to look at other areas where they might be able to better apply their skills. They were mostly unresponsive, which is fine. Someone has to tell them, it might as well be me.
One of the students, however, indicated that “malaria is where the money is.” I couldn’t disagree. The reason that we put so much money and effort into diseases like malaria and HIV is simply because they yield marketable products. Medications for diseases like tungiasis (jiggers) are so simple as to not be profitable, customers too poor to buy them, and governments and donors too distracted by big diseases like malaria, HIV and TB to be concerned with dumping money to provide them for free.
And this is where the problem lies. We have a self propagating system of companies, researchers and donors, which simply float money between one another with little regard for the needs of the poorest of the poor. Breaking the cycle is difficult, but it starts with academics who need to push students to do work with neglected, overlooked or under-researched diseases. Even small grants can support small, but meaningful projects.
We have reached a point where malaria funding for malaria research is yielding ever diminishing returns. Money needs to be put into programs to deliver the tools we have and make ITNs, ACTs and IRS available to the people who need them, who often have trouble getting them. Moreover, we need economic development to make people less poor in developing coutnries so that fewer of their babies die. Human resources in developed countries need to start focusing on emerging (or already emerged but ignored) threats lke antibiotic resistance, Dengue fever, emerging zoonotics and others. That starts with us as mentors.