A search for all articles with “malaria” in the text yields an amazing 33,800 results. Browsing through the headlines is like reading a brief history of the disease as seen through an American lens.
The oldest article is from 1889, a report on a malaria outbreak on the upper Hudson in New York: “An epidemic of a malarial nature is reported from towns along the upper Hudson, one physician in Newburg reporting more than seventy cases under his care. Newburg is famous for its breakneck streets.”
The article is notable because in 1889, very little was known about the disease. Of course, in 2012, we know much, much more, but the challenges (problems in diagnosis, complex and often contradictory observations on ecological factors and socio-economic infection gradients) are the same now as they were then.
“30 INSANE PARETICS CURED BY MALARIA; Long Island College Hospital Reports Marked Success With New Treatment. Thirty patients regarded as hopelessly insane are back at work and leading normal lives after being artificially inoculated with malaria, allowed to suffer chills and fever for two weeks or so and then treated with drugs, according to an announcement yesterday by the Long Island College Hospital.”
I don’t think that anyone really knew what the “paretics” were suffering from, but it was likely syphilis. Malaria was used briefly to treat a variety of neurological disorders caused by infectious agents, with varying degrees of success and failure.
Vaccines have long been “just around the corner,” only to die in sad failure. The most overly optimistic claim came in 1984 from then head of USAID, M. Peter McPherson (who later became President of Michigan State University):
M. Peter McPherson, administrator of the Agency for International Development, said he expected that a vaccine would be ready for trial in humans within 12 to 18 months and widely available throughout the world within five years. ”We think this is a practical schedule,” he told a news conference at the State Department today.
A classic case of overstatement, I’m sure that he regrets this event to this day. No wonder scientists have to be wishy washy with their predictions. Statement like this live in sad perpetuity. We still don’t have a vaccine, and the outlook for having one any time soon hasn’t gotten much better now than in 1984.
1889 North River Malaria
1925 30 INSANE PARETICS CURED BY MALARIA
1925 WAR ON MALARIA BEGUN BY LEAGUE
1938 MALARIA SCOURGE FOUGHT BY THE TYA
1943 Malaria Problem; Our Knowledge Is Still in an Unsatisfactory State
1944 us HEALTH SERVICE COMBATS MALARIA
1945 New Drugs to Combat Malaria Are Tested in Prisons for Army
1946 CURE FOR MALARIA BARED BY CHEMISTS
1948 NEW DRUGS TO END MALARIA SCOURGE
1951 Army Tests Drug as Malaria Cure; Doses Given Troops
1952 un GAINS GROUND AGAINST MALARIA
1957 World-Wide Battle On Malaria Mapped
1961 New Malaria Threat Is Studied At Infectious Diseases Center
1965 A ‘NEW’ MALARIA RAGES IN VIETNAM
1966 Leprosy Drug Reduces Malaria Among gi’s
1970 Malaria Up Sharply in Nation; Most Cases Traced to Vietnam
1971 Drug Users Spur Malaria Revival
1974 Prison Official in Illinois Halts Malaria Research on Inmates
1977 Malaria Spreading in Central America as Resistance to Sprays Grows
1984 MALARIA VACCINE IS NEAR, U.S. HEALTH OFFICIALS SAY
1987 Drug Combinations Offer New Hope in Fighting Malaria
1988 Scientists Report Advances In Vaccine Against Malaria
1991 Outwitted by Malaria, Desperate Doctors Seek New Remedies
1991 Hope of Human Malaria Vaccine Is Offered
1993 Mefloquine Is Found Best Against Malaria
1994 Vaccine Cuts Malaria Cases In Africa Test
1995 Vaccine for Malaria Failed in New Test
1996 Tests of Malaria Drug From China Bring Hope and Cautionary Tales
Clearly, it was well known that cigarettes caused cancer and strokes, even back in 1915, despite the tobacco industry’s fight against scientific claims that carried well into the 60’s and 70’s.
Zion, apparently, was founded as a Christian oasis in a country fraught with sin by a Mr. John Alexander Dowie. In addition to regular (and popular) faith healings, he was also known for waging a “Prayer Duel” with self-appointed Muslim prophet, Hadhrat Mirza Ghulam Ahmad. Ahmad was a complicated figure himself.
It was said that whoever died first during the duel would be exposed as a fraud. Dowie died a year before Ahmad of alcoholism.
Afghanistan’s health profile could be considered to be the worst in the entire world. Infant (1.65/10 births) and maternal mortality (1.4/100 births) are high and life expectancy short (46 years) (World Bank) After years of warfare, an anti-woman Taliban regime, it can be said that even the most basic of health needs have remained unattended to, largely ignored and out of the public discourse.
In 2002, post invasion, the Afghan Ministry of Public Health along with the World Health Organization, UNICEF and United Nations Population Fund established a framework of basic services, which included essential mother-child health care, basic vaccinations, control of TB and malaria, nutrition and basic mental health services. Tuberculosis and malaria (largely vivax) run rampant throughout Afghanistan. Through the proactive efforts of Rural Expansion of Afghanistan’s Community Based Health Care, health care access in Afghanistan has gone from 40 to 77 percent in the past 8 years, but that still leaves more than 7 million people without any access to even the most basic of care. To put it in perspective, this would be equivalent to the entire population of Michigan having no access to any type of health care at all.
While pictures we see of Afghanistan here are largely from the large population center of Kabul, it is forgotten that Afghanistan is roughly the size of Texas and provides home to nearly 30 million people. Afghan residents are spread in nearly every quarter of Afghanistan and largely have little access to basics such as electricity and schools. One of the poorest countries and lagely inaccessible places on the planet, it is no surprise that the country has massive internal challenges to surpass.
Afghan Health Services
The Afghan MoPH maintains a listing of all Basic Package of Health Services facilities throughout the country and has made a database freely available online. There are nearly 800 facilities spread throughout Afghanistan, consisting of District Hospitals, Basic Health Centers and Mother Child Health Clinics. Kabul has the largest number of facilities at 79. Assuming the 115 District Hospitals accept any Afghani seeking care, the average catchment of an Afghan District Hospital would include nearly 270,000 people. To put this into perspective, Michigan, with a population of approximately 10 million people, has nearly 1,320 hospitals. That’s one hospital for 8000 people. Accounting for population and potential catchment areas, there are hospitals (that are likely understaffed and underfunded) which serve more than 1.7 million potential patients (Chahar Burjak Hospital), whereas hospitals near Kabul and Kandahar which serve less than 200,000 people, still an incredible number when placed against the United States.
Hospital Catchment Areas and Civilian Casualties
It is doubtful that local small health facilities are equipped to handle seriously injured individuals. Thus, civilians wounded in conflict events must either make their way to a district hospital, hope for the best from the local facility or do nothing and potentially die. Thus, it would be of interest which facilities potentially serve the largest number of civilian casualties and where they might be located. The map on the right shows the number of civilian casualties as a function of the underlying catchment population. The units in the legend are odd due the the catchments being in millions, but the relative color scales not. Facilities in the southern districts are disproportionately overloaded due the high number of civilian casualties within their respective catchments.
Geographic Access to Health Services
Hospital access, in addition to overburdend by the sheer numbers of the surrounding population are mostly inaccessible to the Afghan population, as the figure on the left confirms. Accounting for elevation, slope and the rudimentary road system, the brunt of Afghanistan has no access to health services. Most areas of Afghanistan are located more than 300 or more kilometers from the nearest hospital.in developing country contexts, 5 km or more is considered to be a market of lack of access to health services. As in all developing countries, facility utilization is strongly related to proximity to services (O’Donnell 2007).
Conflict Events at Health Facilities
Although completely reprehensible, conflict events do occur at health facilities, particularly those which are located in urban areas. The recent “Afghan War Diary”, unfortunately, confirms that they not only have occurred, but are fairly commonplace. For the purpose of this analysis, I considered any event within 100 meters of a health facility to be at the facility itself. Summing over all the events within the 100m buffer, I discovered that none to as many as 25 events occur at facilities, specifically at the Hilmand District Hospital.As many as 31 people have died in attacks on health facilities, and as many as 13 have been wounded in events on or directly proximal to a hospital or clinic. It is well worth noting, that the largest numbers of attacks on health facilities occurs not within crowded Kabul, but rather in the rural northern areas.
Relationship of Distance from Health Facility to Civilian Casualties
Calculating the mean number of casualties per facility by deciles of distance to health facility from the conflict event, I found that the most casualties occur near facilities. Facilities are often located near infrastructure and market centers, raising the likelihood of civilian casualty should a conflict event occur. yet, this calculation is restricted to actual events. Although the mean difference is only slight, the pattern of decreasing death and injury with distance is striking. However, without data on the distribution of households in relation to health facilities, true effects are difficult to determine.
Environmental Determinants of Civilian Casualties
Using available data from GIS sources, such as elevation, distance to water, distance to roadways and distance to nearest health facility, I was able to relate the number of wounded civilians in a conflict event to environmental variables. Using a negative binomial model to determine the statistical significance of possible predictive covariates, I found a best model included only distance to road and distance to the nearest health facility. In fact, both variables required a quadratic term, and both distance to road and distance to health facilities were related to a sharp decrease in civilian casualties as distance increased. Analyzing the estimated coefficients, I found that civilian deaths were at a minimum at 20 km from the nearest health facility, and 7 kilometers from the nearest road. Both were at a maximum directly at the facility, and at the road. This result is, or course, hardly surprising, as people most often reside close to road and close to infrastructure. Still, the pattern of these two variables was interesting, and more interesting was that both retained significance even when included in the same model.
glm.nb(formula = CivilianCasu ~ DisttoHF + DisttoHF2 + DisttoRoad + DisttoRoad2,
data = subx, init.theta = 0.05989177641, link = log)
|Estimate||Std. Error||z value||Pr(>|z|)|
|(Intercept)||-0.8944109||0.0708122||-12.631||< 2e-16 ***|
|Distance to health facility||-0.0806837||0.0116815||-6.907||4.95e-12 ***|
|Distance to health facility^2||0.0023833||0.0003205||7.437||1.03e-13 ***|
|Distance to Road||-7.7975250||2.0432720||-3.816||0.000136 ***|
|Distance to Road^2||24.6081933||9.8147377||2.507||0.012167 *|
Signif. codes: 0 ‘***’ 0.001 ‘**’ 0.01 ‘*’ 0.05 ‘.’ 0.1 ‘ ’ 1
The Afghani health system, already strained to the gills with immense public health challenges, suffers under the brunt of a lack of public funds in a non-existent economy, warfare, a dearth of trained physicians and the massive populations which they must serve. That conflict events which result in civilian casualties occur in the proximity to health facilities is unforgiveable and all parties in this senseless conflict would do well to respect the safety of the Afghani civilian population. While the outlook under the present government is miles above that which existed (or didn’t) under the Taliban, there is still much to do.
O’DONNELL, Owen. Access to health care in developing countries: breaking down demand side barriers. Cad. Saúde Pública [online]. 2007, vol.23, n.12 [cited 2010-11-23], pp. 2820-2834 . Available from: . ISSN 0102-311X. doi: 10.1590/S0102-311X2007001200003.
Zwarenstein, M., D. Krige, and B. Wolff. 1991. The use of a geographical information system for hospital catchment area research in Natal/KwaZulu. South African Medical Journal 80: 497-500.
Using STIS (Space Time Intelligence System) from TerraSeer, I was able to make this animated movie of all US bombing events in Laos from 1965-1973. Dots are sized proportional to the total pounds of explosives dropped.
Note what happens when you get to about 1970.
During the Vietnam War, the US spread combat operations to neighboring Laos. The US secretly waged widespread bombing runs on nearly every corner of the country, as illustrated by the map on the left. Laos experienced more than 30,000 casualties during the bombings, more than 20,000 people have died since bombing ceased in 1974 due to leftover unexploded munitions, and many more tens of thousands were needlessly displaced. A UN report notes that Laos is, per capita, the most bombed country on the planet, with .84 tons of explosives dropped per person from the years 1965 to 1974.
The true extent of the carnage was not known until Clinton declassified military records for the entire Vietnam War. The US military keeps meticulous records of all combat operations, recording the date, precise location, type and number of aircraft and total pounds of explosives dropped. The Defense Security Cooperation Agency’s Office of Humanitarian Demining has been working with the Laotian government to assist in the clean up of leftover landmines and unexploded ordnance. It is estimated that it may take up to 3000 years to clean up all unexploded ordnance in Laos alone.
The U.S. Government spent nearly 17 million dollars every single day to bomb Laos. What it has spent to clean it up, is, as of yet, a pittance (2.7 million a year) and the State Department has reduced this amount even further for 2011. Over 280 million bombs were dropped on Laos. It’s estimated that up to 80 million of them never exploded.
It is through a Laotian demining group that I was able to get a hold of this data set.
The Pattern of Bombing
The United States bombed Laos almost daily for nine years, a country we were not even at war with. Out of 2,858 total days, the United States Air Force bombed Loas for 2,290. Even the Air Force gets weekends and holidays off. Things got really intense in 1968-70 during Operation Menu (Nixon’s secret bombing campaign of Cambodia and Laos), and then spiked again just before the Vietnam War ended.
The military, as in Afghanistan and Iraq, followed seasonal bombing patterns, peaking in summer and falling back during the Christmas season. A time series decomposition confirms an overall peak in 69 to 70, but while the number of bombing runs may have peaked then, the intensity was only magnified. As larger and larger planes came in to the fold (such as the B-52) and smaller craft such as the A-1’s became phased out in favor of the F-4’s, the US military became more efficient in it’s bombing runs, becoming able to drop more tonnage of explosives using fewer aircraft. (It’s incredible what you can learn from data)
The Spatial Distribution of Bombing
The United States bombed nearly every quarter of Laos, but some areas were hit worse than others. In particular, the eastern end of the southern part of Laos, and the area around the province of Xieng Khouang. Areas along the Thai and Cambodian borders suffered less bombing but probably experience the largest influx of refugees.
Relative to the population Xieng Khouang had the largest tonnage of explosives per person dropped on it, followed by the Southernmost province, Attapu. Bombing runs were not uniformly spread across provinces, but appeared to target specific areas more than others in terms of overall tonnage dropped. There appear to be specific hot spots in the south, which could represent any number of things, but none of which are in this data set.
The Vietnam War is widely perceived as having been an incredible policy blunder. That the American government was unwilling to cut it’s losses and stop early was not only a sign of incredible American arrogance, but has resulted in decades of ruined economies, loss of life, and a series of disastrous South East Asian governments, not the least of which was the brutal regime of the Khmer Rouge. This data set, while historically important, should also serve as a reminder of things to come, as the aftermath of the invasion of Iraq comes to the fore. It’s unfortunate that while the Vietnam war is a part of the daily lives of all Laotians, that it rarely registers on the radar of the average American, and if it does, it’s considered to be a problem exclusive to those who served. While the effects of the war on those who fought in Vietnam cannot be understated, the incredible burden that generations of Laotians will experience cannot be forgotten.
Knowing that we were not at war with Laos, the most troubling part of this data set is realizing the incredible monetary expense of the operation. 17 million dollars per day. More than 4 million tons of explosives were levied on Laos. All of which were provided by private contractors such as McDonnell Douglas. I could imagine (although I have no evidence), that the bombing campaigns were less strategic and more corrupt, a dangerous collusion of profit and policy. The secrecy surrounding the bombings make me all the more suspicious. The connections between defense contractors and actions in the Vietnam War and the possibility that the War was extended by those with monetary interests is well worth pursuing. Investigations into the mistakes of Vietnam could go far to inform present day discussions of the merits/demerits of entering long term conflicts. Of course, in the case of Iraq, the milk has already been spilled.
War is devastating in the long term for the US economy. Government spending which could be used to invest in infrastructure and social development projects, is diverted to support an endless war effort. In the short term, however, defense contractors and those involved in defense manufacturing profit. It has been suggested that the workers during the Vietnam war were dependent on defense related manufacturing, so much so, that Reagan’s promises of expanding defense spending helped usher him in office. While our manufacturing jobs may trickle overseas, defense manufacturing must remain in the United States. This creates an internal economy that is dependent on endless war around the world, supported by people who don’t have to fight it. Remember the incredible uproar over the cancellation of the F-22?
I don’t know where I stand on Chomsky besides thinking that he has interesting opinions, but I found this clip interesting. It would be worthwhile to know whether his claims can be verified or not:
NRA, “National Survey of UXO Victims and Accidents, Phase 1,” Vientiane, undated but 2009, p. 39.
Between 1513 and 1867, more than 10 million people were brought to the Americas as slaves. It’s a miserable chapter in human history, yet played a disgustingly key role in the creation of the United States. Researchers at Emory University have gathered records from more than 35,000 slavery voyages and created slavevoyages.org, a research tool that allows you not only to download their incredible data set, but also to create your own reports and visualizations.
Of course, it is estimated that between 12 and 27 million people live in slavery in 2010. In absolute numbers, that’s more than at any time in human history. More than 1.3 million children are trafficked every year, and more than 300 million people, mostly women and children, while not considered slaves in the traditional sense, work under conditions of forced labor. We have much to do.
While at this year’s ASTMH meetings, I happened upon a fantastic poster featuring conflicts in the DRC as associated with malaria outcomes in children. While I won’t go into the specifics of that particular research (paper forthcoming I assume), I will present this map of conflicts in Africa from 1997-2010 that I created from the ACLED database. Conflict is ubiquitous in central Sub-Saharan Africa, bleeding like a festering cancer throughout Central Africa. Border violence upon civilians is unfortunately common. Over here, in the United States, we are too busy being distracted by idiots like Michelle Bachmann to be concerned about what happens halfway around the globe but make no mistake, our economic downturn likely has grave effects for civilians caught in the crossfire of these senseless conflicts, as aid money dries up, political will disintegrates and good governance and African growth fall to the wayside.
There has been a disturbing uptick in conflicts in the past 3 years after a considerable drop during our economic boom years. However, violence against civilians continues, fueled likely in part to oil and resource grabs by first world countries, and a wide availability of guns from around the world. In particular, billions of dollars of American weapons flowed into Africa during the 90’s under the Clinton admin. Africans will use whatever they have as long as they can. Weapons don’t just go away and US and European small arms manufacturers profit at the expense of kids in Africa, while the US government, in bed with the gun industry, turns a blind eye. Ironically, it has been suggested that guns and supplies which flow into Africa to fuel these stupid conflicts are manufactured in part using US prison labor through the US government’s sanctioned slave labor unit UNICOR for not more than $1.15 an hour, labor which largely consists of the descendants of African slaves.
While this post is rife with sweeping generalizations and unsupported conclusions, in my mind it is highly likely that American big business profits off chaos. As long as people argue and fight, markets for violence are created. As long as Americans are distracted with their own political chaos as encouraged by the American right, these companies will freely operate in the shadows. Citizens are easy to control when they feel that they are in danger and power for business easy to consolidate.
Today, I made a short video documenting all combat incidents involving deaths (in Michigan colors no less). I mapped the kernel density of the points using the spatstat package in R. You can watch the entire Iraq War in just over 1 minute!
Using this method to visualize the war presents some really interesting results. The war starts out and conflict pretty much occurs all over the place. Around the time of the surge, fighting becomes intensely concentrated around the Baghdad area, but quiets down for the rest of the country. Events slowly start to move north, so that all of Baghdad and the northern area are regions of intense fighting. By the end of 2009, things begin to quiet down again, but with some sporadic events spread over the countryside again.
At the time of the surge, I am reminded of Agent Based simulations, and wonder if the increase in intensity of fighting in Baghdad actually propagates itself, forcing insurgents to concentrate resources in Baghdad at the expense of the rest of the country. As fighting dies down, and need for fighting decrease, insurgents leave the city, taking the fight with them. My theory would be that intense fighting concentrates combat events more, whereas mid-level and low intensity fighting allows conflict to spread geographically, due to distribution of resources.
As the surge increased the number of US soldiers in Baghdad, insurgents were forced to concentrate their resources withing the city, reducing their ability in fighting for control of outlying areas. Clearly, this is to the strategic advantage of the Occupying force, as they do not need to expend incredible resources fighting a war over a large geographic space, and, with superior firepower and technology, they are able to quash a large number of insurgents in a small amount of time. It could be a bait and trap tactic, but clearly it is to the incredible disadvantage of the civilian population. While likely not the target of US forces (seriously, what would be the merit in that?), they clearly become a target of insurgents and candidates for widespread suicide terror campaigns. Insurgent deaths are maximized at little financial and temporal cost, but civilians become caught in the cross-fire and become an easy target of fear-based propaganda strategies. Whether this was truly the strategy behind the surge, is up to speculation. It’s also very possible that insurgents had previously moved into the Baghdad area with the same strategy. Obviously, this isn’t something I have thought through very deeply, but it’s worth exploring.
After being told that it was a hoax (by a kind reader of this blog who didn’t really say it was a hoax), Wikileaks released more than 400,000 military records from the Iraq war covering the years from 2003 to then end of 2009. This data will likely be ignored in the present political climate, but the historical and scientific significance of this data dump cannot be underestimated. It’s shocking really, that nearly a decade fighting two major wars, tens of thousands of American and civilian dead and trillions of dollars later, the Afghan and Iraq wars are a mere blip in a political climate that would allow a moron like Christine O’Donnell the chance to fill a Senate seat. We have truly become a Confederacy of Dunces, in the worst way imaginable.
The current press is touting this massive database as a smoking gun in the American involvement in Iraq, and will most likely play up the juiciest and most damning elements. There will be analyses of further torture past Abu Ghraib, civilian death counts which do not match previous estimates, but in all the finger pointing, the true extent of human costs of the war will be lost. It is to this end that I seek to inform and not blame. The war was wrong, based on lies and sold to an uninformed and uninterested American public coming out of 9/11 and still weighing the meaning of being drawn into a state of vulnerability to international terrorism that many other countries had been living in for decades. I do not present my analysis to point a finger at anyone as the players in the Iraq War are so many and the intricacies far outside my area of knowledge.I merely wish to illustrate the incredibly meaningless costs of warfare, through the scientific tools at my disposal. To this end, I will be presenting a series of statistical analyses of the Iraq War over the course of the next week.
Data: The full data set contains more than 400,000 records, but I have limited my working dataset to only those records which contain deaths. There are four categories of people contained in the data set, friendly (coalition), enemy, Iraqi army and civilian. Both numbers of dead and numbers of wounded are noted, but record keeping may or may not be 100% accurate. However, given the large number of records, it is quite likely that a significant percentage of them reflect more or less accurate numbers.
The map in the upper left of this post represents points of all deaths in Iraq between the beginning of 2004 and the end of 2009. Incidents are recorded for nearly all populated locales in Iraq, particularly those along major roads. Baghdad, of course, has the largest number of incidents. Breaking these up into civilian and coalition casualties, we get a more complete picture of how violence is distributed within the country. The maps below represent full country deaths and wounded, with dots proportional to the number of casualties. Larger dots mean more casualties noted in the record for that day, smaller dots mean less. Dots in all of the maps are to the same scale. That is, the size of each dot represents the same number of casualties in both civilian and coalition casualty maps below.
The differences between the two are striking. Many, many more civilians die and become wounded in conflicts than US and coalition forces. This is not to belittle casualties within the military, but the number are beyond disproportionate. Zooming in one Baghdad, the disparity is even more pronounced:
Whereas civilian deaths and wounded are splattered over Baghdad indiscriminately, US and coalition casualties are rather limited. Of course, the US military has the advantage of armored military vehicles, body armor and weaponry, but it cannot be denied that the greatest toll in human life is waged by the insurgency itself through suicide bombings, conflicts in open air markets and free for all urban warfare. Our presence in the country likely created the conditions necessary for such carnage, but I doubt that the American public ever had any clue as to the extent. Maps such as these make it clear the extent to which the Iraqi people have suffered and the stupidity of warfare.