Emily's Worldview

I have been in Kenya for 3 1/2 days now, and an hour ago was the first time I walked somewhere, anywhere, of my own power. I'm in Nairobi, a city with veins of wealth amid an ore of poverty, and it is along those veins that I have been traveling since I arrived. So it was a taxi from the airport to work at the head office, a ride home every day, and a ride to work in the morning. I had arranged to stay with the family of a Kenyan fellow-student and they were lovely and I enjoyed staying with them. But it was clear that worrying about getting me to and from work was very stressful for them, so I moved into an American fellow-student's nice apartment yesterday (being paid for by her summer position). Of course it's more comfortable, and the official white landrover rolls up in the morning to ferry us to work. The office is mostly Kenyan, but mostly headed by Americans, and all my work has been on the computer and on paper. The only thing that has been foreign to me so far is actually the experience of being in a formal office environment, something I had mostly managed to avoid till now.

I feel disoriented and nowhere in particular, like I never left the airport and am still in transit. Which I am, really. In a day or two, I will head to the smaller town in the West and there crime is not such an issue and I will be working independently on my own project, which looks to be very cool. I think after 8 weeks in small town Africa, I will be glad to come back to Nairobi. Right now, I can't wait to leave.

I've been meaning to post this for a while...here is a link to my article that was published in Context, an online student journal. It is about trying to access health care for a boy while I was in Tanzania, and it is all true.

I try to avoid doing this on the blog, but I'm desperate to find some way to help my friend finish his school. He is Tanzanian and I met him when his mother hosted me in Tanzania for three months in 2005. His father died about 10 years ago, and his mother was one of three wives. A sponsor brought him to Quebec, Canada and enrolled him in an English-language private school (Isaya doesn't speak French). He just completed the equivalent of his high school junior year and wants desperately to finish his school outside of Tanzania, because the education system is much better here. Getting him to Canada was very difficult and took a lot of sacrifice on the part of his family. Now there is a serious drought in Tanzania and the economy is suffering; as a result, Isaya's mother can't afford next year's school fees.

He needs US$4,600 by May 24 to pay the rest of his school fees for his last year. The sponsor is hosting him at her house and he has a job to make his own pocket money. I have already explored every other option for him--moving to an English-speaking part of Canada to attend public school, coming to America, trying to get a loan--this is the only feasible way for Isaya now to finish his education and not get sent back to Tanzania. I am trying to get the school to lower the fees and I'm in contact with some local charities where he is, to lower the cost. If you have any leads at all on who can contribute anything, please let me know by email or by commenting here.

The newest US foreign policy outrage is in Somalia. Yesterday’s Washington Post story about US government support to certain Somali warlords believed to be against al Qaeda, is brand new bad news. Somalia at the moment is not a functioning nation-state; it’s a set of territories that are constantly under contention by various warring factions. There is hardly any humanitarian presence, all the teachers sell khat for a living because there are no schools, and civilians die at unknown rates from disease, violence, and accidents. The country is a haven for drug smugglers, arms dealers, international fugitives and, yes, terrorists. BUT FUNDING VIOLENT WARLORDS IS A TERRIBLE RESPONSE.

I’m no historian and my knowledge of many regions and periods of history is weak, so it is possible that covert US funding of armed insurgents or paramilitary forces has somewhere established democracy or toppled a bloodthirsty leader. But I do know that US funding and covert operations are at least in part responsible for the rise of corrupt and violent Mobutu Sese Seko in Africa, for the ongoing instability in Haiti, for bloody overthrow in Nicaragua and, oh, the rise of the Taliban. Covert support in this case is in direct violation of a UN arms embargo and undermines the closest thing to a legitimate government that is there. In a situation as complex as Somalia, I truly doubt that there are any ‘good’ guys, much less that we would know for certain who they are. Even if there are some that are “better” than others (as determined by their potential threat to the USA, of course), support to any violent faction means more guns, more violence, and more death. All of the factions abuse human rights, and all have blood on their hands. Now we know that our government does too.

It's a pretty exciting time to be interested in public health issues and international development. At the school of public health, we roll our eyes about the job market, what with the rapidly expanding enrollment in MPH programs, but I'm beginning to feel like I'm a part of something new. Of course there are my fellow classmates, who are currently in the process of dispersing to do their summer research in Mongolia, Peru, Senegal, Botswana, Indonesia, Montana. But it seems like I am also constantly being connected with people my age (mostly women, but that's another blog entry) who are in Africa, or in the public health world, or doing peace corps, or looking at public health education opportunities. My debate coach from college is doing it, my friend who directed a play I was in in high school, the daughter of my mother's colleague, the new youth leader at my old church. I used to think I was an anomaly for wanting to build a career around serving people in Africa. Now I see that I am part of a community of creative, enthusiastic, and determined people, and it is a very exciting group to be joining.

As if it wasn't already hard enough to find affordable medicines in developing countries, India's new patent laws are threatening what is already a meager trickle of lifesaving medications. India's pharmaceutical industry has long relied on producing high quality generic equivalents of medicines, some of which pharma had claimed were too complicated to produce in the developing world. These drugs were then distributed throughout the developing world, and long before pharmaceutical companies agreed to lower prices on AIDS drugs, HIV patients were getting better on Indian-produced generic versions of antiretrovirals.

Since the new laws were enacted last year, over 9,000 patent applications have been filed, mostly by international pharmaceutical companies. Pharma wants to seize its opportunity to shut down the factories that are the backbone of international public health initiatives. Gilead, an American company that produces tenofovir, an essential antiretroviral, want to stop production of its generic equivalent in India. They claim that since they are already selling this drug at cost in qualifying countries, there is no need for generic manufacture. But it's a lie--Gilead was supposed to register the drug in 97 countries, and now it is registered in less than 10. So those 87 countries, where generics can be purchased can't afford that medicine now. Gilead, and the other international pharmaceutical companies, want to reinforce the current global system that ensures continued big profits for western manufacturers and continued ill health for the world's poor. Let's hope that the protesters in India, and around the world, can stop them.

So folks have been asking me about the NYTimes article about how male circumcision appears to prevent AIDS. As you can probably guess, the "AIDS world" is all abuzz about this too, and having a new weapon to fight HIV is always welcomed.

I think the article does draw out the major points on this question. The evidence is strong, but not conclusive yet. It is surprising that men are willing to sign up for this operation that has no cultural basis in these countries (a sign of the desperate fear around HIV). And the big concern is that men who have been circumcised will be more likely to undertake other risk behaviors. As a result, would decreasing men's risk increase the risk to their female partners?

So it appears that a circumcised man has up to a 60% lower risk of becoming infected with HIV. But we have something that does better than that--they're called condoms and they're over 90% effective in this population. And you don't need a surgeon to distribute condoms--you just need a trained peer educator or a community awareness group. Africa is rich with community groups and community associations, it is poor with skilled doctors. The hype around this intervention makes me nervous. Are we so eager to have a magic bullet to fight AIDS that we won't weigh the potential trade-offs for other illnesses? Men want to be circumcised to lower their risk of HIV. But all of these countries have women suffering from the effects of obstetric fistula--where difficult deliveries turn them into social pariahs because they are unable to control their urine or feces. A straightforward surgical procedure would cure them, so what about them? People going blind from trachoma, people dying from injuries from car accidents, babies with cleft palates and Hirschsprung's Disease. In Africa, surgical resources are abundantly rare and abundantly necessary for other afflictions, so circumcision may not be the good news we need.