Emily's Worldview

Long update from a far land

2009-07-12T20:39:00.002-05:00

It's been a long time since my last big email update, and welcome to those of you for whom it's my first. I think just because my adventure in Tanzania turned into a pretty normal life--too much work and too little time for travels, the grocery store, TV at home, this person's going away party, that person's birthday drinks. Then last week, one of my staff members died suddenly and everything became terribly abnormal. A young healthy guy, he had been complaining of headache for a few weeks--the doctors treated him for cerebral malaria, but it may have been a bleed in his brain. He never had access to a CT scan.

Sammy was tall and chubby, and the nicest, most earnest person you could meet. Every day when he was done with his work for the day he would ask if there was anything else I needed help with. His shoulders shook when he laughed. With both of his parents deceased, he was the head of his siblings. He had just taken a loan to pay for his sister’s send-off party and her wedding. He was reminding all the staff not to miss the party. But instead of laughing with the MC at his sister’s sendoff, he was in the morgue, and his relatives were talking about buying his coffin and carrying his body home. His sister heard the news when she was in the salon, getting ready for the party. Now she sat with the other women, and cried.

I’m tired of seeing people die for no reason, especially when they’re trying so hard and struggling to make a life for themselves and their families. Like Sammy, and like the HIV-positive people we serve who get to the hospital only to get bad care, and like women who die in childbirth because the hospital is too far or too poorly equipped (a heartbreaking article in the Times). It's overwhelming to think about what Tanzania needs to do to catch up to the West in health care. But the situation is desperate, something my normal easy life here sometimes obscures.

And there are terrible contradictions I live with every day, knowing the sad and desperate situation of Sammy's widow, and still going out at night, splurging on Western food in town--croissants and cheese. I composed most of this email in Zanzibar, on a trip with my friend Kate that we had already planned, and I've had a great series of visitors from the US, including my mom last summer and my dad this year. At the office, we've hired a new driver, and we are busy with summer interns and volunteers. Sadness creeps up, then gets swept away. I am honored and happy to be here, seeing the progress our organization is making. Getting out of bed in the morning is easy because I see the impacts we are having in the villages we serve. But the contradictions get to be a lot to contain in one life.

Hard Work

2008-05-11T05:34:00.000-05:00

Oh wow, it's May?!? My, it has been a while. Time flies when you're working in a frenzy most of the time. Work is good. It's amazing, in fact. The problems I had with my staff are gone and meetings for the moment are more like a gathering of friends. In the villages, we are continually well received and recently several organizations we've been courting agreed to partner with us. Our numbers are great--number of people getting tested, number of HIV-positive people enrolling for services--and we have a thriving new branch in Babati, an even more underserved area. We recently organized a field trip for the entire Arusha staff to Babati. We descended on the small town and trained 80 people and tested 300 in two days. In the evening, we took part in the HIV-positive club's exercise night, running over red-dirt roads as neighbors said hello, dogs barked, and children ran alongside. It was a great way to exercise. I came back from the trip with dysentery, but never mind. Never eat fish in an inland village, that's another lesson learned.

But there's a cloud over all the good work that is going on, and that is money. Apart from the field trip (and recovering from my GI problems), I've mostly been in the office, feverishly writing proposals to get us through our fast-approaching crisis. It's frustrating because we're so good at what we do in the villages, so good at delivering and monitoring and following up our services, and so bad at raising money up to now. I mean, we are getting people living with HIV in dirt shacks out of bed and back to their daily affairs and we are getting grouchy old Masai men with four wives to get tested for HIV, and that's the easy part. Things are looking good in the long term fortunately; some of these proposals are sure to pan out (as sure as these things ever are), and we will always have the volunteer program to keep us going. But right now, we are facing down some serious cuts, and we need help. If you can, please click here.

And the other night, I threw a party, to celebrate a few of my friend's babies, to say goodbye to one of our staff members, and to celebrate one whole year in Tanzania. It was a great mix of everyone I know in Arusha, the international set, the Tanzanians of all ages and genders, gathered around and making speeches, then eating heaping plates of good old Swahili food--spiced rice and fried chicken and bitter greens and salad and meat sauce and bananas. There was a cake, so we sang the cake song ("Cake-y Cake-y") and told jokes and ate too much and kept the baby's fingers off of the snack tray. Moments like that are so much sweeter when I think about what I've been through already and the other life I am missing back home. Swiftly, beautifully, time passes.

Washed Away

2008-04-28T10:57:00.003-05:00

It was supposed to stop raining weeks ago and it hasn't stopped. After our adventure in the mire, the next thing to go was the bridge on the shortcut to the office. One morning, pre-caffeine, I went to turn left and ran into the African traffic cone--some cut branches in the road. No more shortcut--the bridge had been washed away.

When I finally made it to the office, a visitor was waiting, from a small community organization from one of our villages. The school's toilets had been swept away in the recent floods, and the children had nowhere to relieve themselves. Could we contribute? One of my staff members came back from yet another village, where he couldn't do any work because the whole village was at a funeral for three people who drowned in a pond. The people in the village who know how to swim were out in their fields when the first person jumped in and the other two drowned trying to save her.

When I got back from India, all the talk was of how great the rains had been and how well the corn was growing. Nowadays the talk is of just how ruined it is. Last week, I drove up one of the best village roads left, which still had sheets of water flowing across it. The tallest corn still looked good--leafy and tasseled--but the shorter stalks were yellowing from the bottom up. One of our community volunteers shook her head and said that now the plants would just make leaves and no corn. Although it is fun to see children playing in swollen creeks, grown adults tromping around in rubber boots, and the sleek coats of animals fat from the green grass, there is a grim time coming when the rain finally stops and there is little to harvest.

Today one of the few roads in town is closed because another bridge fell. I am staying at the office late to write this post and to give the resulting traffic jam some time to subside. Outside, it is raining.

Glory

2008-04-13T07:58:00.002-05:00

Glory is my roommate and my best friend in Tanzania. She is about five foot two and has a sweet smile and unassuming presence. She is my age but looks about 16. She loves to make outrageous statements about her strength and her wealth and her proficiency in English. She teases me for reading too much, for being a slob, for skipping showers, for not going to church anymore, for being sleepy. We watched the first season of Heroes on a bootlegged DVD together, me translating roughly into Swahili, and she loves to squeeze her eyes shut and pretend that she can teleport like Hiro. She has no control over our misbehaved guard dogs and when they jump up on her she screams. She won’t let me get a cat because she thinks it will eat off the stove. Sometimes, when I run into her away from the house, she is wearing my clothes.

Glory is an evangelical Christian and blasts the religious radio station every night when she is cooking. She used to speak in tongues around the house, but recently stopped. She doesn’t drink or go out at night unless I take her. Although she speaks no English, she loves to meet my foreign friends. She remembers every guest we have ever had and loves to tell stories about them—Kate who was white like paper, Ben who had a pet pig, a volunteer we called Little John who spoke his own version of pidgin Swahili.

Glory was alone in our apartment when it was robbed by men carrying giant knives in 2005. We have both seen each other when we were sickest and weakest and most out of our minds. Sometimes when I go out she tells me I am half naked; the other night I wore my most plunging top and she told me I looked nice. Some nights when I come back late she will call me from her room as I get ready for bed in mine. I've come and gone from Tanzania several times since I first met Glory, and every time we've said goodbye, both of us have cried.

Stuck

2008-04-13T07:45:00.003-05:00

Back from India, I found Tanzania awash in the worst of rainy season. Our cars got mired down daily out in the villages but never so bad as the Wednesday after I got back. A group of our staff members got stuck, badly, in the mud at about ten in the morning, and by four that evening were still stuck. They had spent the day searching for a tractor, but they were all out tilling the fields and none were available. The only option was for us to send another truck and a towrope and pull them out.

All the other trucks were late coming back from the field, so I set out with Anton, a lovely Rastafarian staff member with a ton of experience driving in the villages. He volunteered for the task and I was glad to have him along, though I knew he had a heavily pregnant wife at home and she would worry if he was late. The village was far away, and by the time we reached the area, we had only an hour or so of daylight left. Land that is usually dusty and barren was now a lake on both sides of the road, and as we got closer we saw houses that had been knocked over by floods. The road was a joke, a streambed really; it was obvious we would get stuck soon and I fumed that my staff had chosen to try to navigate these ridiculous roads. And then we were stuck, the rear fender of the car resting in the mud, the rear two tires spinning uselessly.

We were near a school and the guards there came out to help as the light waned, but the situation only got progressively more hopeless, no matter how many rocks we threw under the tires, how much pushing they did, or digging, or leveraging with boards. Now we had two cars stuck a mile apart from each other, the batteries on everyone’s cell phones were dying, we were in the middle of nowhere, and it was dark.

But soon a tractor passed the other stuck car which did not have a towrope, and our friends sent it to us, who did. The tractor had no headlight so rumbled up out of the dark, and was almost out of diesel, so the driver yelled at us to hurry. As the men fumbled with the towrope, I jumped behind the wheel. It felt marvelous as the tractor yanked the car out of the mud onto solid dirt. Problem half-solved.

We decided to have Anton walk to the still stuck car, and escort the other staff members to the freed car. I waited at the school, watching the cooking fire of two Masai guards. They said nothing, asked me nothing, and only laughed when an enormous cockroach landed in my hair and I screamed. Finally, Anton and the others emerged from the darkness, all in good spirits and laughing heartily. We piled in the car and began driving out the loooooong way, dropping two of the villagers who had helped us as we went. We finally got to the tarmac road, and at that moment, still at least an hour from town, the sky opened up and dropped the kind of rain that is basically like water poured from a massive bucket. I drove carefully, nervously, slowly through the rain, exhausted and scared and wondering what we could have done differently to avoid this whole mess. We got back to town at one am, Anton's wife in tears and all of us spent.

The next day, we sent another car out to retrieve the one that remained. It got stuck as well, and both had to be rescued by a tractor called away from the fields. They pulled into the office at five pm, both coated with mud, at the exact moment a well-meaning researcher from Northwestern University asked me “And how are the roads in the areas where you work?”.

India Journal: Part 6

2008-04-13T07:42:00.002-05:00

All that remained for me was to say goodbye to David and get back to Delhi. The second day of Holi involves a lot of throwing of colors (in liquid and powder form) and a lot of drinking, so I was direly warned by the hotel manager about the dangers of traveling alone as a woman on this particular day. I had no choice, so I decided to jump on an early, deluxe bus and rely on my now well-honed “Piss off” face.

But, despite the assurances of multiple people, the buses were not running that morning because of the holiday, and a group of powder-stained drunk guys was following me around the station. I jumped in a rickshaw to the train station, which the driver also assured me was closed, and could he recommend a hotel? “Just take me to the station,” I growled, and we went. He was a liar, and I told him so after I booked my ticket and threw him his fare. Soon I was waiting on the platform with my backpack on and a cryptic ticket in my hand. Aware that I should probably not be talking directly to men without my brother with me, I asked a group of Muslim women in black robes if I was in the right place for the train to Delhi. They stared at me, giggled, and turned away.

I was baffled as the train finally pulled into the station and grateful for the guy with a roller suitcase and a blackberry in his hand who showed me where to get on. He spent the next four hours beside me, telling me about the instant connection he had felt to me back in that train station and the desire he had for me to meet his mother. Sadly, he had to get off before Delhi. At which point the cute guy across the aisle struck up a much more interesting conversation. He was one of the famed Indian IT workers living in Delhi, bringing his young niece and nephew to visit their aunt, his sister, for the holiday. He was not yet married, he confided, but would be in a few months. His parents and sister had chosen a bride for him, and he liked her, though he had never actually met her. I asked him if that wasn’t weird, and he said he thought it was okay. “My parents have more experience, so I think they know what is best for me,” he said. Huh.

Outside the train, villages passed full of pink and green and purple people, covered head to toe with the Holi colors. Whenever we neared inhabited areas, the windows of the train would slam shut, as open windows invited bucketfuls of colored water and fistfuls of powder. As we neared the city, the slums backing up on the tracks were winding up the holiday, with some people crouching by the water taps, scrubbing the colors out of their hair. I liked this as my last vision of India: colorful, riotous, a mess that is slowly getting cleaned up.

India Journal: Part 5

2008-04-13T07:35:00.002-05:00

I forgot to mention that underlying the journey up to now has been my ongoing saga with the Ethiopian Airlines ticket office in Delhi. Ethiopian has by far the cheapest Kilimanjaro-Delhi ticket and by far the least reliable booking system I have ever encountered. I was cancelled off my flights twice in the weeks before my departure and as a result was on a waiting list for my return flight. Every morning and afternoon I called the Ethiopian office and had the following conversation:

Me: Hello, I would like to confirm my flight from Delhi to Kilimanjaro.
Hani, the Ticket Agent: What is your reservation number?
Me: DJGIR63
H,tTA: I am not able to confirm that flight at this time please call back this afternoon/tomorrow morning.

Was it Einstein who said that the definition of insanity is doing the same thing over and over and expecting a different result? And how many American sounding women were calling that office and trying to confirm a spot on that flight? Couldn’t I even get a “oh hi, Emily”?

Anyway the upshot of all that was that my return flight was delayed by two days so that we circled back to Jaipur, The Pink City, to catch the Elephant Festival. On our previous visit there, earlier in the trip, we had been unpleasantly overwhelmed by the size and the bustle of the city and having seen the major sights, made tracks. I think we imagined the Elephant Festival as a massive parade down the streets of town, huge decorated elephants narrowly passing the cycle rickshaws and fruit stands as colorfully-dressed Jaipurians cheered and threw confetti.

In reality, it was a fairly sedate, yet delightful affair. It was held at the stadium and the majority of attendees were white and came by the busload. The parade circled the grassy stadium and the elephants were great, their faces and trunks encrusted with gems and painted with pictures of tigers and flowers, their backs draped with velvet and topped with a proud mustachioed rider. Despite all the elegance, the elephants still swept the ground with their trucks, snacking on bundles of fresh-cut grass. Between the elephants came marching bands and dancing troupes, from tribal dancers dressed like monkeys to girls with giant peacock tails. The tourists snapped a million pictures.

That night was the first night of Holi, which is celebrated with bonfires. As we left the stadium, these bonfires were being set up in public roads, right in the middle of town. Sheaves of dried grass propped up over sticks with kites and other bits of color were set alight even as regular traffic continued to pass. The fires were huge, and the feeling was part insurrection, part campfire. At some of the fires, holy men in white said blessings, at others families burned more grasses to take to their home’s temple. As dark descended, the fires were left unattended, and subsided to coals.

India Journal: Part 4

2008-03-30T12:29:00.002-05:00

I think I can honestly say that Pushkar is the most bizarre place I have ever been. For us, the weirdness started in nearby Ajmer, where we got off the bus from Bundi and spent a long time wandering with our backpacks on trying to figure out where the onward buses to Pushkar (11 kilometers away) left from. Finally aboard the bus, we were stopped by some kind of officials about 20 minutes into the journey. 20 minutes after that, everyone got off the bus and we were back to wandering around, trying to get over the mountain to Pushkar. A motor rickshaw driver laughed heartily when we told him we would pay him anything if he would just take us. Not allowed.

The entire time we were being repeatedly called by the proprieter of the hotel we had reserved. He called us at least six times in the two hours it took us to move five miles. When we met him, we were sweaty and grouchy, but he was a handsome, smiling man dressed all in white linen with a stripe of color on his forehead. He was like a cool breeze from the shade of the hotel, and David and I drank mango tea and fresh juice on the roof, reading our books and trying to recover from the afternoon’s journey.

The town of Pushkar itself centers around a small and sacred pond (I just can't call it a lake), which has white marble stairs leading down to it and temples and places for pilgrims to bathe in the holy water. Surrounding this is a gaudy bazaar geared mainly towards foreign tourists. In this bazaar, I can’t make this up, there are bookshops selling bootleg novels, juice stalls selling lassis made with marijuana, sword stands, and holy men trying to get you to take a proffered flower or to touch the lumpy growth on a sacred cow festooned with shiny fabric and bells. Traversing the bazaar are non-Indian tourists who are mostly dreadlocked and dressed in billowing genie pants, non-Indian residents dressed all in linen and exuding their peace with the world, Indian pilgrims with their towels and packets of petals, motorcycles, bicycles, camels, cows, and dogs.

I feel like the Hindus have made a mistake in holding both free-roaming cows and bare feet sacred. As dusk fell, we slipped off our shoes in respect and headed down to the edge of the pond. “Good tourists,” an elderly man dressed in a white tunic congratulated us. We picked our way gingerly around cow patties and sat on the white stairs, warm from the sun. We watched flickers of flame light up around the edge of the water. Groups of worshippers clanged bells and beat drums, but they eventually quieted as the darkness claimed the sky.

The other India Journal

2008-03-30T12:26:00.002-05:00

You can get David's take on all this, plus read about his onward adventures at

http://churchmanistan.blogspot.com

India Journal: Part 3

2008-03-30T12:22:00.001-05:00

Exhausted from cities and palaces and trying not to be swindled, we nipped off to the small town of Bundi. The bus ride to Bundi was another small adventure, me almost getting left at a bus station as I struggled to repress a bout of nausea. When I finally lost that battle loudly into a plastic bag, the driver, who I was sitting directly behind, and the other passengers took little notice and the bus continued racing forward, swerving sickeningly around slower vehicles.

The town itself was a lovely jumble of light blue houses in a small valley overlooked by an old, delightfully ruined fort, and we were warily led to a lovely guest house, the walls painted with dancing women and warring gods. Once I had recovered, we explored the town’s delights including huge step wells, dozens of decorative temples, the fort, the old palace with faded but intricate paintings, a small but serene lake, and a concoction called a Saathi Lassi. Creamy yet spicy with cardamom and studded with cashews, raisins, and flecks of cinnamon; heaven in a cup.

At the unfortunately named Elephant House Hotel, we met some fellow travelers; French, Argentinian, Spanish, and Swedish who had been on the road for 5, 6, and 8 months, mostly in India. To be honest, I can’t imagine it. It was week 1.5, and we were already catching our breath. But maybe it gets easier with time, maybe you can relax more when the months of traveling stretch out before you. For us, each day was a precious gem, and perhaps that made them harder.

India Journal: Part 2

2008-03-22T07:09:00.002-05:00

Delhi was a bit much, even as we took refuge from the madness in the city's public parks, tombs, and movie theaters (Bollywood! Decadent costumes and dance numbers for three hours, anyone? No english subtitles, sorry.). So we jumped, with every other tourist, onto the Taj Express and soon were poking around the architectural wonders of the trash-city of Agra. We worked our way up to it, marveling at the lesser marvels such as the 400-year old fort modified by successive Mughal emperors then busted up and used as an armory by the British, and magnificent river-side tombs with bits of blue enamel still in place. And the Taj itself, once you get past the confusing security regime (why isn't my guidebook allowed in?) is marvelous and perfect perfect perfect. We spent a long time people watching and waiting for a beam of late-afternoon sunlight to break through the clouds and catch the dome which, for 15 seconds, it did. Heaven on earth.

We scampered to a nearby village for a day trip and a ramble around the beautiful old palaces, mosques, and tombs. One grave, surrounded by a shelter of intricate marble carving is said to bring luck to women hoping to conceive--in prayer these women tie multicolored threads to the marble lattice. We enjoyed it until the would-be guides overwhelmed us and we fled.

India Journal: Part I

2008-03-16T05:09:00.003-05:00

My brother David and I are traveling in India! The trip did not get off to an auspicious start. While David was in India being scammed by the first two taxi drivers he met, I was in Tanzania first rebooking my plane ticket, cancelled by the airline, and then hunched over a toilet in homage to some questionable meat I had for my last dinner in Arusha. But I made it to the airport, and on and off the appropriate planes, and soon David and I were reunited at our hotel in Delhi.

And it was all so...India. The streets all crammed with people, cows, horses, bicycles, rickshaws, and stands and stores selling every kind of food and fruit and drink and shiny brightly colored thing. At the monuments we visited in the city, Indian people gaped at us and the old buildings in turn. We gaped back, taking in groups of young men in Eurotrash jeans with slicked hair, women in vivid saris with red bindis, men in turbans, babies with their eyes lined with kohl. We found a place to eat, managed not to get hit by any cars, browsed in the market.

We were pleased with ourselves for navigating the city successfully as we jumped on a bicycle rickshaw to go from a historic mosque to a Bollywood movie theater. The driver seemed confused, however, about where we were going and kept stopping to ask for directions, taking an ever more circuitous and deserted path. But when we said the name of the movie theater and the circle it was on, he smiled and nodded, and repeated what we said. Then, on one of his shortcuts, we came around a corner and saw a group of children holding water balloons on the roof of a building. No, no, no, we shook our fingers at them; 1, 2, 3, the balloons hit their marks.
Emily and David, welcome to India.

Top Five

2008-03-08T04:53:00.000-05:00

Sometimes I complain about my job here, but I don't have to look far to find people with worse jobs. After careful thought, and based on the intimate knowledge I've gained from watching people work out of my car's window, here are my top five contenders for worst job in Arusha:

-Wheelbarrow puller. These are not Radio Flyers, but car-size wooden wheelbarrows piled with concrete blocks or entire couch sets. They are backbreaking to pull uphills and perilous to ride down. Oh, and you have to put up with the maniac drivers on the same road.

-Subsistence farmer. I can barely lift a hoe. Much less use one to clear an entire field with a baby on my back, housework to do at home, and the water tap miles away.

-Housegirl. Usually brought from the village, I've seen them as young as nine, and they are pretty much 24 hour slaves to the biggest mama in the house. They get criticized for everything they (or anyone else) does wrong, and get no thanks. They are expected to work from early in the morning till the last dish is done at night. A recent wage reform requires them to be paid the equivalent of $55 dollars a month, which was widely laughed at, since everyone knows the going monthly rate is about $25. Oh, did you want an off day?

-Construction worker. This mostly involves carrying buckets of rocks and sand from place to place on your head. Boots and hardhats for foremen only.

-Lumberjack. Backbreaking defined; on easy days you are on one end of a two-man saw. Hard days involve rolling entire trees on and off of trucks using machines such as ramps and levers.

The Kilimanjaro Marathon

2008-03-08T04:49:00.001-05:00

On a recent weekend, my friend C from graduate school came up from the coast to spend a weekend up north. The occasion? The Kilimanjaro marathon and half marathon, starting in the town of Moshi. Moshi is a more provincial version of Arusha, with a tiny town center surrounded by tree-lined roads converging on tidy traffic circles (Roundabouts or "Keep-Lefties" to the locals). It is an hour's drive from Arusha. The day we arrived was a Saturday, the typical day for weddings, so the circles were choked with jubilant wedding processions, and on the streets women in party dresses mingled with runners in wind pants and white people who had come from all over East Africa.

After dropping C off at the start line, I took my place as enthusiast/water girl midway up a long hill right before a great view of Kilimanjaro, and waited. The stretch of road was flanked by coffee farms, and from the rows of bushes some children emerged to see what I was doing. We watched the first elite marathoners go by, then eagerly watched for, in order, the first African woman, the first white man, and the first white woman. The race was a distorted version of the marathons I've watched in America: a large pack of elite runners at the front, followed by a small group of gradually more and more casual runners all the way to the people at the end who look determined, but undertrained and in pain. While all of the elite runners looked East African, most of the slower runners were white.

Eventually I got my young fellow-spectators to clap for the runners as they went by. C showed up on pace, eager for the gatorade and sports gels brought from America for the event. I saw her going up the hill, and coming back down, then drove through unfamiliar backroads to meet her after she finished. The villages I passed through were beautiful--red soil and green banana trees--and the people smiled indulgently as I leaned out the window and asked politely how to get to town. I bought a bunch of bananas for my runner and nearly broke my arms helping the woman selling them lift her tray off her head. She probably had 60 pounds of bananas on her head, and was still miles from her market, an everyday feat of endurance.

In the dusty stadium where the race ended, vendors sold popsicles, pineapple wedges on skewers, roasted chicken, and Kilimanjaro brand beer. There were unending announcements over the loud speaker and tents handing out free stuff to the runners (Vodacom t-shirts, Tanga Cement headbands). We hung out for a while but the early morning cool had given way to mid-morning heat, and it was time to head back to Arusha.

The Visitor

2008-02-24T07:47:00.004-05:00

So you may have heard that President Bush recently stopped by Arusha on his trip around Africa. Members of his 900+ retinue were visible a few days before, obvious military types hanging out in strange places, like the white man with a laptop in the maternity ward of a hospital Bush was to visit. (The head of this hospital is a minor tyrant who has threatened more than once to kick me and our organization out of his district; I am not looking forward to the new size of his ego with a picture of himself and Bush on his wall).

While local people were overall thrilled at the visit and engaged in a frenzy of painting and road grading to show an Arusha that was up to snuff, I was struck repeatedly by all the manifestations of American arrogance. At the start of one of his speeches, Bush greeted a crowd of dignitaries with "Mambo vipi?", the equivalent of starting a speech to a group of prominent African-Americans by saying "Wazzzzzup?". The thousands who lined the streets were miffed when the motorcade zoomed by without so much as a wave (on TV, he had been shown shaking hands with people in Dar). The Secret Service also saw fit to more or less shut the town down for his visit. About 55 kilometers of road were shut down from 8 am to 5 pm, with thousands of people lining them. Even bicycles weren't allowed to cross and there was a shortage of fresh milk in town because the dairy farmers in the hills could not cross into town. Trying to move in the opposite direction, we had to cancel a community outreach day in one of the hill villages. The local newspapers carried articles from miffed businesspeople in Arusha and Dar who wondered why it was necessary to close the roads.

Overall, people were excited and proud to have the visitor, curious to see him, and quick to trade gossip about his itinerary and what he did (jumping in imitation of a Masai dance was a favorite). Myself, I had a series of nightmares where I met the man and could think of nothing civil to say.

The news in Tanzania

2008-02-09T07:44:00.000-05:00

While Kenya has been continuing its political and economic freefall to the north, Tanzania is quietly experiencing a different kind of revolution. Last Thursday, one of my young staff members came to the office with a portable radio blaring. The prime minister had just resigned, a day after having been publicly implicated in a rotten deal for emergency power last year. $170 million had been lost to a briefcase company in the US and people were angry. More resignations followed and the cabinet was dissolved. This came on the heels of another scandal involving similar amounts of money stolen from the Bank of Tanzania. The director of the Bank of Tanzania was fired.

When President Kikwete was chosen as the ruling party's candidate in 2005, many people saw his youth and pronounced drive against corruption as a new start for a party of big men who began their careers in the independence era. Last year, Kikwete started with the party leadership, chasing away some of the most wealthy and well-connected operators. Now he has an opportunity to take more decisive actions against the blatantly corrupt members of parliament, and he has a public and political mandate to do it.

Up until Sunday, people had been riveted by the African Cup of Nations (a soccer tournament that Tanzania failed to qualify for for lack of a single goal), but now people at the barber shop next door to my house are gathered around the television watching late night sessions of parliament. With Kenya in tatters, a visit from the US president, and Kikwete assuming the head of the AU for a year's term, this is a big moment for Tanzania and everyone is excited. Some people, including me, think that Kikwete can strike a blow against corruption and set an example for the continent. Rooting for a better government is more exciting than any soccer cup!

The news in Kenya

2008-01-31T10:28:00.000-05:00

The pictures and the news from Kenya are shocking. Nobody predicted things would go this wrong this quickly, and it is hard to reconcile the flaming cars and machete-wielding crowds with what I saw when I was there.

One of the largest flashpoints right now is Kisumu, the town where I spent my summer in 2006. Some of my friends who live there have fled to Nairobi to avoid the mobs that have looted even local schools as the students fled the approaching crowd. When I was there, I was charmed by the dreamy lakeside feeling, the carwash/fried fish places, the hordes of bicycle taxis that are the town’s primary mode of transportation. I can’t imagine it now—shops on the main street looted, the few local Kikuyu families killed or driven out with police escort, buses burned in the main stand where we started our weekend trips. I wasn’t there long enough to know the local politics in and out. A lot happened in the local language that I missed. But I never ever would have believed it would be a site for riots and ethnic cleansing.

For now, the impact in Arusha has been small. Prices are up, again, and there are an unusual number of tourists, as the overland trips shift from Nairobi to here and people reschedule their Kenya vacations. Tanzanians with relatives in Kenyan schools are nervously watching the situation, and one of our Kenyan staff was delayed coming back from Christmas break as her police-guarded convoy passed through road blocks set up by local thugs. The whole time, the road to Nairobi has been open. But mostly we, like the rest of the world, are just nervously watching the news.

Timber

2008-01-31T10:22:00.000-05:00

I started thinking last Saturday, when the power was out all over town, and a crew of men came and chopped all the branches off the tree across from our office. In town, the lady at the supermarket told me that the power company had switched off all the power to avoid being electrocuted as they trimmed branches that were encroaching on power lines around town.

Sunday afternoon I was driving in my neighborhood and saw a row of full grown trees that had been chopped down to jagged stumps. Over the felled branches, my neighbors crawled like a horde of termites, hacking off the leaves and trimming the boughs to firewood length and bundling them onto the heads of children. Free firewood, what a lucky day.

I thought of the logging trucks that come rumbling down through one of the areas we work, in the foothills of Mt. Meru. The big trucks stop halfway down the mountain and unload all the poles, whole trees really, in an incredible display of grunting and muscle, onto borrowed lots. Another truck winds its way up the mountain and the men reload the poles, using ramps and sticks and rhythmic chanting to get all the trees back on. As the reloaded truck rumbles down the hill, chickens and children and women with firewood on their head scatter.

An old Swedish man lives in the same mountain foothills and gives every villager a free sapling who asks for it, but farther up the mountain, the former forest is now fields of potatoes and beans marked by red jagged stumps. A nearby ravine is too steep to farm and shows the tangled jungle that these tidy rows replaced. I gasped when I saw a colobus monkey jumping among the vines and the children accompanying me laughed.

Driving outside of Lusaka in Zambia in 2002, we saw miles and miles of scorched earth, the trees harvested for charcoal for the hungry capital. In the slums there, it is sold in gunny sacks and the people selling it are blackened by the soot.

At home

2008-01-22T09:58:00.000-05:00

The cast of characters at home includes Butch, the Vicious Puppy, Julius, the Gentle Guard, and Glory, the Best Friend. We also have a rotating cast of visitors including my friends from back home, Glory's friends from church, Julius' friends from who knows where, and some stray cats that Butch gives what for.

The house is very comfortable. Three bedrooms, two bathrooms, a living room, and a kitchen; hot water and a big tank so that we are not subject to water shortages (just power outages). It's pretty much all furnished now, including a vanity for Glory and a reading table for me. We cook and eat and watch DVDs or read or talk. Sometimes I play with Butch until I get tired of being savagely mauled. Recently, Julius and I have been transferring the plants to new pots, a fun project that involves getting muddy and fending off Butch attacks. Sometimes, though, I am exhausted from work and fall asleep without showering, my dirty feet hanging off the edge of the bed. I wake up at some point to turn off the light, and then the next morning when light comes through the window.

Help us, we're broke!

2008-01-14T11:40:00.000-05:00

All joking aside, we really do need more resources to continue the work we've started--preventing new HIV infections, and caring for those who are living with the virus in northern Tanzania. Here's more from our Executive Director:

Help SIC win Parade Magazine's Giving Challenge by donating $10! The eight organizations with the most donors by January 31st win an additional $50,000 , and this is money we sorely need to maintain the quality of our services as we expand into a new region of Tanzania in 2008. You can donate by clicking here. (Note: This is not the same as giving through Facebook - donations in the challenge must go through this link.)

This is an opportunity to give a $10 gift that will make a real difference, since it is the number of individual donors for each organization that matters. If we win, the power of your donation will be multiplied many times over by the $50,000 prize. Please consider passing this on to friends and family. We have over 250 volunteer program alumni, and if everyone donates and persuades three friends to donate, we will be comfortably in the lead despite a late start. Making a donation yourself and asking others to do the same are great ways to support the organization.

Note that because we are use the Network for Good online giving system, we are listed in the US domestic section of the competition. However, all funds raised will be used in Tanzania. We are listed under our old name, since we can't fundraise as 'Support for International Change' until our paperwork is approved by the IRS.

Please take two minutes and $10 to support SIC in 2008.

Happy New Year,

Matthew Craven
Executive Director
Support for International Change
www.sichange.org

A new year in Tanzania

2008-01-14T11:26:00.000-05:00

Well. It's been quite a while since my last update, and I've spent a long time trying to figure out how to share everything that happened. I guess I can start with last August, not long after my last update, when what started out as a misunderstanding at a weekly staff meeting escalated very quickly into basically a strike by the Tanzanian staff. All fingers were pointing at me. My boss was called in, and the board of directors in the US, over allegations that I was difficult to work with, moody, and mean. Not being used to self-doubt, I took the whole thing like a punch in the stomach, and that might be why I haven't sent an update in a while.

Things were much better after a couple months. We managed to have very friendly and productive contract talks and the atmosphere in the office is much lighter, much more fun. Some of the staff told me that they understand me better now, and I feel like the work I've put in to building relationships has been very well received. But five months ago, I thought everything was fine too...

As that crisis abated, I was able to settle comfortably into the grind of this job and the nightly routine of falling asleep in my clothes. One of the most gratifying aspects of my position--the variety of tasks that it encompasses--is also one of the most frustrating. On a daily basis, I am responsible for the accounting, reports, driving, what's going on in the villages, meeting potential donors, "networking", writing proposals, answering emails, overseeing car maintenance, purchasing, hiring and firing, and keeping morale sunny. Plus the occasional task that comes up. The night before my plane took off for the States for a vacation, a few of us were wrapping up details in the office when we heard the sound of falling water. Our office had flooded from the upstairs (don't ask) and we spent two hours mopping, moving furniture, and bailing water out of the building in buckets. It was time for a break.

In the event, my Christmas vacation was more of a whirl than a rest--time with my family and with friends from high school, college, and graduate school--a kind of movie-montage version of my old life in America. I enjoyed it, a lot, and managed to mostly skip over the culture shock, finding myself only occasionally disoriented in supermarkets and traffic. I wasn't really ready to get on the plane, but the day arrived, and suddenly I was back in Tanzania. Stepping out of the plane, the humidity of a Tanzanian summer night felt welcoming and warm. Driving back to town, I was overcome by the smells--cooking fires, banana trees, dust. They were so familiar and yet as exciting as the first time I landed here, more than five years ago.

So the Emily Update is back, emilysworldview.blogspot.com is back, and I am back where I want to be, even when it's hard.

Weekender

2007-08-07T23:11:00.002-05:00

A 6 hour drive to the Ngorongoro Crater to visit a small but promising NGO sounded like a fun weekend trip, and I definitely needed a break from the office. Yet 6 hours in, we were in the middle of a vast plain, dotted with gazelles, and very far from our destination. Two hours later, we stopped for lunch under a huge baobob tree, populated by a group of black birds croaking "wow". Three Masai men left their herds nearby to visit us. They ignored me, being a woman and all, and asked my Tanzanian companions for water. They gestured to their only drinking source, a small pond crusted over with salt. I offered peanut butter sandwiches, realizing the irony of my gift only after we had driven off.

After 10 hours of driving across a seemingly endless plain, we finally reached our destination, jolted, dusty, and at least one of us on the brink of nervous collapse. We were gently welcomed to a tidy mud house with warm water for bathing and a greasy beef stew. I pulled myself together. But the light was fading, and we were leaving the next morning, so if we were going to see the project, it had to be right then. We went to visit some of the families that the project was serving. At a cluster of houses, we waited for a local leader. Children gathered and giggled, dressed in red blankets with white beads around their necks and ankles. Women with elaborate earrings stood shyly to the side. When the leader came, he drove his herd before him. Their bells sounded beautiful in the evening air.

The next day, it was back to Arusha. This time we took a shortcut, which guided us over several minor mountain ranges, the road alternating dust, slippery rocks, and sharp corners up and down the mountainsides. After a few hours we came over a hill, and Lake Natron shimmered on the valley floor below us, silvery and vast. We made our way down the sleep incline, and around the lake. Then it was past Oldonyo Lengai, the old volcano that has been causing earthquakes recently. Steam issued from the top, and zebras grazed calmly at the base. Then it was across more plains, dust pouring in the windows, until finally we reached a marvelous asphalt road. "Wouldn't you like to stop and get the dust off?" my companions asked. "No," I said, grouchy from all the driving. Only when I passed by a mirror later did I realize that my face and whole body was coated with dust. That night there was no hot water in the shower, and the next day was back to work. Not a very relaxing weekend, but at least a minor adventure.

Moving in

2007-08-07T23:11:00.001-05:00

I was comfortable at my friend's house, even with the two cats, dog, and seven puppies who all came running every time I opened the gate. We cooked at night and carpooled together in the morning. But I was ready for my own place, a non-work space, that had a lot of plants but a lot less pets.

t took me about two months of traipsing around Arusha with a realtor, visiting various options ranging from creepy-dark to African-dictator-luxe, to finally find a place. When I found it, I visited three times, demanded some fixes, then got stuck on the price with my landlord, a large and somewhat deaf old man who was not going to budge. But I wanted that house. Bitterly, I closed and paid six months rent--totaling about $1900.

And the house is great. Three bedrooms and two bathrooms with lots of light, partial wood paneling on the walls and ceilings and beautiful built-in cupboards. The kitchen is awkward but has a huge pantry, and the whole house has hot and cold water. The neighborhood is safe and friendly, a mix of houses, apartments, stores and barbershops, convenient to town but not too hectic. I recruited Glory, my old roommate, to come live with me again, and we spent one Saturday on a Price is Right shopping spree--refrigerator, mattresses, mats, stove. The neighbors stared as we pulled up to the house with our loaded pick up.

There was more to do. I spent hours in the main market haggling over kitchen ware, and in the used clothes market bargaining for linens. I spent a day in stores choosing the fabric for my couch, dazzled by bolts of cloth stacked floor to ceiling, presided over by Arab traders. I hired a guard, had shards of glass cemented on the walls, and ordered a dog house for a small but particularly vicious puppy from my former home. From a roadside nursery, I bought climbing vines for my front porch, and a row of weird and leafy plants for the entry. I went to the supermarket to stock the cupboards--thinking that once there was food in the house, I'd be ready to move in.

But things kept happening. A toilet ran and we had to shut the water off. The plumber had to come three times because I forgot the first time, then didn't have the right keys. We needed a counter for the kitchen to put the stove on. Glory's phone broke for a month and I couldn't get a hold of her. I ordered couches and all sorts of furniture, but picked a bad carpenter who took the money and won't finish, even though I visit him every few days and beg, cajole, threaten. Next time I see him I'll take our head driver, who has an air of menace, and the time after that I'll try crying. I just want my damn couch.

It got to be too much--last week I gave up and moved in. The only furniture is mattresses, mats, and four plastic chairs. We can't use the stove yet because we still have no counter. I've been learning the light switches, and identifying more things to buy--towel racks, mirrors, an electric kettle. On the Saturday I finally moved in, I sat in front of the house and listened to the wind in my neighbor's banana trees, and the trumpets from wedding processions on the nearby main road and felt good.

Arusha 6 am

2007-08-07T23:11:00.000-05:00

Dropping a friend off at the bus station for an early trip to the Usumbara mountains, I drive through the whole city at 6 am. The night before at 7 pm, we took half an hour to move six blocks, as the evening traffic clogged around a minor accident. Now, in the pre-dawn, the streets are dark and empty of cars, but already bustling with people. At the Air Tanzania office, tourists load suitcases into the airport shuttle; at the market, women carry big bundles to their stalls. Tired maids trudge to work and tired night guards trudge home. A runner passes, a drunk staggers home. At the station, touts and thieves and ticket sellers bang on the car and ask where we are going. Other passengers, dressed in their Sunday best, carry handkerchiefs, bread, suitcases and scurry to their buses. Barely awake, we marvel at the people who have been up and walking for hours, making a living and moving before the sun comes up.

More firing

2007-06-23T15:56:00.000-05:00

First, a caveat; overall our staff are wonderful. They are the heart and soul of the organization , and I adore working with them. It's just some hires...

Today I had to fire a driver. It was difficult one, because he was the first person I ever directly hired, and two because he wept and begged and pleaded for forgiveness the entire time. I had plenty of reasons to fire him—routinely late, complaints of dangerous driving, allegations that he showed up drunk one day, and paper proof that he was stealing gas money. We gave him a last warning. It was all perfectly reasonable and justified and entirely his fault. And originally I was furious at him for everything. But I still felt sorry when he realized he had ruined his opportunity and fell to pieces in front of me. I spoke soothingly, and held myself together until he left. Justified or not, I couldn’t relish it. Not at all.

The chungu

2007-06-23T15:53:00.000-05:00

Two weeks before my first day at the office, there was a nighttime robbery at the office. Despite the fact that drawers were dumped out and windows left wide open, and despite the fact that the encircling houses all had guards, nobody heard anything. The police threw our guard in jail. Then after a day or two they contacted the person who had my job and presented a choice; either they would transfer our guard to prison, or they would drop the case. She decided to drop the case and gave the guard two weeks to find out who had done it or where the things were, or else he was fired.

On my first day, another staff member took the guard aside and told him that we were serious about firing him. The staff member urged him to do something to save himself. Then and there, the guard decided to break the chungu.

What is the chungu? It is a clay pot that, once broken, kills the person it was intended for and his offspring as well. Some Maasai people in and near Arusha believe very strongly in it. To break the chungu, you must consult the elders in your village, you must advertise for forty days, and then you must pay a handsome sum to bring the correct people to your house. You also have to choose a tree to break it on

So here is the management dilemma: you like your guard and don’t think he was involved in the robbery (though he was almost definitely fast asleep). You would like information leading to the arrest of the perpetrators and possible recovery of the stolen items. You would like everyone to know not to mess with your organization. But you also have staff who don’t believe in the chungu and would not like to be associated with it, and you have staff who do believe in the chungu who do not want the robbers’ blood on their hands. For breaking the chungu to get you what you want, you will have to advertise widely that your organization has entered into this business of black magic.

Before we had all the information, we initially agreed to break it. When the guard brought the elder from the village to talk to me, we learned for the first time about the expenses associated with it, and the question ended up being a matter of cost and not of culture. We fired the guard, and settled up his account. A matter of paperwork, typical office stuff.

Living

2007-06-13T16:03:00.000-05:00

Well, despite appearances, I did not get on a plane at the beginning of May and fly off the face of the earth. No, I landed safely in Arusha, Tanzania and began work the next day. The last month has been a torrent of learning and new experiences—Swahili vocabulary, new accounting software, driving on the left and off-road, meeting new people, searching for old friends, setting up my new life, the one I always wanted.

My work is awesome. In the morning, I arrive early to check emails that came in overnight, and to be there to greet everyone as they come in. We have five Tanzanian field officers, who run our programs in the field. They are amazing—outspoken, very bright, and committed to their work and to the communities they serve. Our counseling team is comprised of a portly older man, a grizzled Rastafarian, and a young Kenyan woman with a sweet smile. We have two professional drivers and a full-time mechanic who make up a masculine, jokey crew. We have a guard at night and a part-time cleaner who comes twice a week. Before I arrived, the entire staff minus one counselor climbed a steep and treacherous peak in Masai land. Erica, the Volunteer Programs Manager from California, organized the trip and in a reflection of her fun personality, made certificates congratulating everyone on reaching the top of the Mountain of God. The last set of characters are our three trucks—old Landrovers named Bobby and Bongo and a Landcruiser—each with their own quirks and personalities that can make or ruin everyone's day.

In the office I work on monitoring, I design program evaluations, I update the calendar, I enter receipts, I write proposals and emails and budgets. Sometimes I run errands in town; sweating in line at the bank, buying office supplies in dim shops, waiting for a sluggish photocopier. Arusha is the same as it always was, but a bit nicer—the streets bustle with vendors and businesspeople and laborers, but these days there are more tourists around to divert the truly annoying hangers-on. With a fast stride, no eye contact, and a few sentences in Swahili, I can usually lose them within half a block.

Away from the office and out of town is even more interesting. I jump on a truck with one of the field officers to follow up our school peer education program, driving for miles past scrubby trees on a dusty track, until suddenly we reach a neatly swept classroom block with hundreds of students milling around and desperate, well-dressed teachers stranded miles from anywhere. We conduct community health worker training on a rainy day, barely making it up a slippery mountain road to meet six serious people in their Sunday best, thoughtfully taking notes as we explain the program. We conduct HIV testing at a Masai market outside of town. Outside, people draped in red and blue blankets sell goats, cows, bananas, cooking pots, soap. Inside, in a hot little office, I prick work-hardened fingers, and capture drops of blood for the test. The simple strip works like a pregnancy test—if the second line appears within a few minutes, the person has HIV. That second line is a heartbreaker every time.

At night, after work, there are a few things to do in Arusha. At the house where I'm staying, we observe the nightly dramas of two cats, one dog, and eight blind puppies. If we go out, there are excellent Indian restaurants and open air grills serving marvelous chicken, roast bananas, and fish grilled with spicy cabbage in foil. There is a backpackers bar that does a semblance of Mexican food, three Chinese restaurants, and the fancy tourist hotels for a break from it all. Some of the more recent, and more surreal, additions to the Arusha nightlife include a fully-equipped movie theater with cushioned seats and popcorn and movies from a month ago, and a tiny karaoke bar with Japanese snacks and karaoke videos in Japanese, English, and Swahili. The latter is always packed.

I am looking forward to the coming months—getting deeper into the work, driving the big trucks, finding my own place and moving in and making it my own. It is sad to be far from people I care deeply about, and to feel too immersed here to email as much as I would like. I can't deny that I'm already looking forward to the Christmas break. But I also can't deny that I have the life I was looking for.

Driving lesson

2007-05-13T12:58:00.000-05:00

Four of us had gone up to a hillside village to speak with the local leaders about starting a community health worker program. On the way up, I practiced driving for the first time. The car is an old, enormous landcruiser with no power steering, and a sticky gearbox that had recently been rebuilt. The wheel is on the right side. The staff member who is teaching me to drive assured me that this road was much easier than most others I would encounter. It was a combination of ruts, ditches, piles of sharp-looking rocks, and slick patches of mud frequented by animals, women with loads on their heads, and darting school children. I drove for maybe half an hour and my arms and legs were shaking from the effort. I did not get stuck and I did not hit anything, and I did not even stall out. But that big heavy truck moves, no matter what is in front of it or under its wheels. And even though I had been nervously watching the other SIC drivers and the challenges they took on, all of the sudden I couldn’t wait for the second lesson. The next frontier will be town, with its fluid definitions of lanes, aggressive drivers, and creative pedestrians. I'll be in the mix, high off the ground, above a diesel engine.

Relocation

2007-05-13T12:56:00.000-05:00

For those of you who don’t know, I have been hired to a two-year contract with Students for International Change (www.sichange.org), based in Arusha, Tanzania. My title is Tanzania Managing Director, and I am directly in charge of the non-volunteer related programs in the rural areas around Arusha including education outreach, mobile testing services, support of anti-AIDS clubs in schools, community health workers, and whatever new programs make sense to assist people living with or fighting HIV in these areas. I am overjoyed and excited about this position because it promises to provide hands-on, day to day management experience, but also experience with program development and proposal writing. It should be an enormous challenge, often frustrating, but also a lot of fun.

The last few weeks have been a blur and my apologies to everyone for my distractedness and abrupt departure. Two weeks ago, I was working three jobs, wrapping up my thesis, finishing four classes early, 100% not packed, and trying to say goodbye to everyone I knew. I made it out of the country as scheduled, but I didn’t get to prepare as much as I had wanted to, and I definitely did not get to spend enough time with everyone at the end. So, my apologies for that, and my thanks for the well-wishes and support. It's hard to believe I'm actually here.

Murder

2007-04-05T22:04:00.000-05:00

A brief news blip last week...a man shot a woman at the CNN center, before being shot by hotel security guards. The woman died at the hospital, the man remains in critical condition. For a moment it was big news--the shooting disrupted the CNN newsroom and there was compelling footage of the victim and shooter lying bleeding as security guards held them at gunpoint. Breathless accounts by CNN employees dominated the stories about the shooting, including one CNN producer who recounted his close call--the shooter had shoved past him, dragging the woman by her hair. When the identity of the victim, an Omni Hotel employee, became known, police labeled the murder a "domestic dispute" and it dropped off the news pages. The fact that nobody famous, or nobody employeed by a famous organization, was further imperiled meant that it was no longer interesting. We didn't need to know anything about the victim other than her name, age, that her job was restocking hotel minibars, and that she somehow died in a domestic dispute in a public place after other people had watched her be dragged through a busy building by her hair.

The nice thing about terms like "domestic dispute" is that they make the rest of "us" safe. We only happen to brush up against the problems of "other people"--they don't really enter or affect our lives. Poor people are convicted of violent crimes more often than wealthy people, but they are also the victims of violent crime more often. The way this story was reported just underscored that divide. "Our" safety was compromised only by coincidence. But the truth is there is no safety until everyone is safe, even the 22 year old with a low paying job and a dangerous ex-boyfriend. We have to find a way to grieve her.

Hard times in Harare

2007-03-27T10:17:00.000-05:00

In his old age, Mugabe's losing his grip, and Zimbabweans will bear the brunt. Never subtle, Mugabe drew the world's attention when his thugs attacked, killed and intimidated white farmers off of their land, but not when he drove the economy into the ground and cleared out slums with bulldozers in parts of the city that happened to be heavily suppotive of the opposition. His armed gangs have trashed and closed down the country's free press, have beaten civilians into reciting loyalty oaths, and has done so with impunity because of his status as one of the heroes of Zimbabwe's liberation and his tactic of blaming his country's problems on Western imperialism. By the way, current inflation is 1,700% and everything, everything is under government ration.

This week Mugabe made it into the international pages by sending heavily armed policemen to a prayer vigil led by the opposition, where they brutally beat the leaders of the two factions of the opposition party. Imagine turning on the TV during the 2004 presidential campaign and seeing John Kerry escorted to court with a huge gash on his forehead and an eye swollen shut. The US and Europe already have targeted sanctions on Zimbabwe, and have spoken out, but their words and actions have been dismissed as imperialist rhetoric.

It would seem that Zimbabwe has come to a turning point, but which way will it turn? Mugabe's party is ready to see him go, but he may decide that, in his 80s, he is ready for another term. The opposition party is divided and may spend more time on infighting than on rebuilding the nation. The archbishop of Zimbabwe has called for mass peaceful protest. After years of silence, African leaders are finally ready to condemn Mugabe's government and this Wednesday Mugabe will attend talks in Tanzania. What will happen next? Will the world be watching? 12 million+ Zimbabweans hang in the balance.

The Thesis

2007-03-15T00:20:00.000-05:00

I'm handing in my first full draft tomorrow and had to provide a lay summary. Thought it might be interesting to those of you who have been watching my page count go up (73!)

* * *

HIV can be transmitted from mother to infant during pregnancy, in labor, or after delivery during breastfeeding. In developed countries, mothers who test positive for HIV receive a combination of at least three antiretroviral medications and use replacements for breastmilk to feed their infants. With these interventions, fewer than 1% of HIV infected mothers transmit HIV to their babies. In sub-Saharan African countries, however, only 10% of pregnant women have access to antiretroviral medications or breastmilk replacements. Without interventions, 30-40% of these women will transmit HIV to their infants.
WHO recommendations for prevention of mother to child transmission of HIV (PMTCT) in low resource settings is a combination of two to three drugs taken for a few weeks prior to labor and delivery. This efficacious regimen reduces transmission to below 5% in these settings. But the majority of the women in Africa who have access to PMTCT receive single-dose nevirapine, where they take one pill during labor and the infant receives one dose of liquid medicine after delivery. With this regimen, roughly 8 to 15% of infants will be infected. This thesis asks the question: What policy changes are necessary to move away from the single dose nevirapine strategy towards wider implementation of the more efficacious regimens?
On the international level, there are UN agencies, multilateral donors, bilateral donors, and international non-governmental level. Governments of the countries in Africa also play a key role in policy making and goal setting for PMTCT. Finally, a number of factors affect the effective implementation of the PMTCT programs. By looking at a case study of a change in the choice of primary drugs for malaria in several countries, I will provide analysis and recommendations for each of these levels of action—international, national, and implementation level.

Goodbye Alice

2007-03-13T19:54:00.000-05:00

I won't try to be original in this post. I opened the email entitled "tragic death" idly, not expecting to find a familiar face grinning back at me. Alice was a genius MD-MPH who spent more hours at school than anyone else but was always ready to laugh about it anyway. On a visit home, she was struck and killed by an empty school bus, turning left. So it is that you can be visiting your mom in New York and step into the intersection, beckoned by a walk sign that you'll never reach and that's it, that's your life, thanks for playing. As for the rest of us--mother, busdriver, acquaintances, bystanders--the pieces are ours to pick up and carry as we wake up each morning and step off the curb.

Teeth

2007-03-12T01:14:00.000-05:00

I've been thinking about teeth lately. Other people's, mostly, as I pretty much take mine for granted. Growing up with parents who were federal employees, dental care was always covered, even some of the cost of my braces to close the two matching gaps where no adult molars grew in. At 17, braces seemed a near-universal rite of passage, like taking the SATs.

But in my internship at an outreach center serving Atlanta's homeless population, I've realized what a blessing having lifelong access to dental care is. Most of our guests have had at least one tooth pulled for tooth decay, and many older adults are missing most of them. They may have had dentures at some point but in the chaos of their lives, they have broken or been misplaced. I honestly don't know how you manage when you have nothing to chew with and no way to control where your food comes from and what it is. Having no teeth slurs your speech and changes your appearance. There is an agency that provides free cleanings adn extractions; for too many of my guests, it is too late for that. For anything more serious, you have to pay. So they remain in pain and at risk for worse.

Recently, a young boy near DC died from complications related to an untreated abscess in his tooth, despite the fact that his mother had been trying to obtain care for him and his siblings. Today I heard the story of a working class woman in Atlanta who is struggling with mountains of debt from treatmes for complications from an abscess that she couldn't afford to treat, because she was uninsured. In America, in 2007, people are suffering from conditions that we have been treating since the middle ages.

A client

2007-03-04T02:23:00.000-05:00

8, 6, 4, 1 and 7 weeks. Those are the ages of the children my client, an African-American woman a year older than I am. I am at my twice-weekly internship at a homeless service agency downtown. As we fill out papers I ask if she is currently pregnant, and she laughs out loud and says no, thank God.

She is getting her life back together, living in a transitional women's shelter, recovering from addiction, abiding by the terms of her parole. When I ask her if she likes the place, she gushes: it's clean, it's safe, they have great classes that teach her how to manage her anger and how to fight addiction. She says that if she had known how nice it was, she would have brought her children with her. As it is, they are staying with her partner's family. She has asked so much from them that she feels she can't ask for the $10 she needs to get a copy of her birth certificate. That is why she came to our agency, and I help her fill out the form and send away for the document, to be returned in three weeks.

This is the type of tiny victory the agency specializes in; the administrative tasks that help homeless men and women to reclaim their dignity and their citizenship. With clients like this, we feel like we are succeeding. More to come.

Public Health Geeks

2007-03-02T00:16:00.000-05:00

Things that happen at the school of public health:

You reach into a pocket of your backpack and a condom falls out because you can't seem to walk into the building without getting handed a free one.

The student government president gets elected on a campaign to provide more free...carrots.

People stay at school until 11 pm just so they won't have to pay for parking. It's not a lucrative field, shall we say.

You're having a sophisticated evening out and the conversation turns to poop, and/or sexually transmitted diseases, and/or the coming plague.

People ask you where, not if, you did Peace Corps.

People don't use hand sanitizer because they're afraid of antimicrobial resistance, and they throw away perfectly good food because they're afraid of food poisoning. Basically, we're terrified of bacteria.

Everyone laughs heartily at jokes that include the words "p-value".

War at home

2007-02-27T23:33:00.000-05:00

I recently attended a panel on the mental health consequences of war. One presenter talked about Tibetan refugees living in India. Another talked about preparing and caring for the mental health needs of American soldiers going to Iraq. But the most affecting, and the most horrifying came from what one professor here calls "a small developing country called Downtown Atlanta".

The setting for the study was the public hospital, an emergency room that is the de facto primary care provider for too many people in Atlanta. The study was meant to look at the distribution of traumatic experience and trauma symptoms in a general low income population, so they randomly sampled patients from the waiting room, and asked questions about sources of trauma and response. What they found was horrifying. 50% of the women had been abused sexually or as a child. 30% of all the people surveyed had lost a friend or relative to violence within the past year. The majority felt unsafe in their neighborhoods. The figure that stayed with me, though, was 10%. That is the proportion of people who had witnessed the murder of a friend or relative just within the previous year.

Of course, with these experiences this general population had high rates of post-traumatic stress disorder and other stress symptoms. It was a punch in the stomach for me. A reminder that a few miles from where I fret about homework and go to sleep safely, other people lie awake, thinking about the horrors they have already witnessed, and those to come.

Student life

2007-02-27T00:49:00.000-05:00

I spent some time today talking about stress with a group of fellow students for a class project. On a scale of 1-5 almost everyone put their stress levels at 3.5 or above. People cited sources of stress I had never noticed or thought about. One felt that other students were competing with her; another felt that her sexual identity was marginalized. Others worried about thesis data, health insurance, body image, curriculum. Almost everyone was stressed by friendships and school deadlines. Here we are in graduate school, at what is supposed to be a relatively leisurely moment in our lives and we're so wound up that in a one hour focus group people started talking about their mothers and about how they overeat when they're stressed.

And here I am. It's 1 in the morning. I have been at school since 10 this morning: class-project-appointment-work at one job-work at another job-homework-thesis-homework-personal project. I've been staying at school to do work because our internet at home has been erratic, and because I can get more done and stay up later working when there's no bed calling me. It's good to be productive, but quite dehumanizing. I'm ready for life after school.

Up to the table

2007-02-25T22:56:00.000-05:00

One of my favorite fundraisers is Night of 1000 Dinners. At Emory, we try to get students organized to do it and help them send out invitations and publicize, but it's an international event and anyone can get involved.

Basically, people sign up to host a dinner between March 1 and April 4, and invite their friends. The night of the dinner, guests, instead of bringing wine or another gift, bring a donation for Adopt-a-Minefield. It raises gazillions of dollars for mine clearance and mine education, but it's basically a party with your friends. Their website is www.1000dinners.com.

To do list

2007-02-25T00:52:00.000-05:00

What do you do when you know you are going to move overseas for at least two years in ten weeks? Here are some of the items on my list:

-Order contacts

-Buy sensible shoes

-Dentist

-Pack, unpack, then repack

-Reschedule finals

-Sell furniture

-Finish thesis

-Give plants away

-New backpack

-Drive home

-Last good haircut

-Visit old high school

-Write a will

-Finish thesis

-Sell car

-Business cards?

-New clothes

-Blog consistently

-Read up on everything you haven't learned enough about yet which is everything

-Talk to any professor that would be a good source of advice which is everyone

-Inform current employers

-Pass Environmental Health, your last requirement

-Carry out the extracurriculars you've never had time for but already committed to

-Quality time with everyone on this continent

-Finish thesis

-Download more music

-Buy good books

-Order good magazines

-Finish thesis

-Fundraise?

-Tell everyone you know

-Breathe and

Prepare yourself

Deciding

2007-02-23T21:44:00.000-05:00

Despite being so enthusiastic about the offer (I went out and celebrated the same night I got it), I wanted to be absolutely sure when I said yes. So I spent the next day talking to the people who would find something wrong with it: my academic advisors, career services people, my family, a few of my most trusted friends. They each walked me through it in their own way, asked all their questions, and reflected back what they knew about me. Each time, when I explained, I tried to make it sound like a decision I was agonizing over, but they all saw through me. All of them, even my parents (once I convinced them that I would be coming home to visit every year), agreed it was perfect for me and I would be crazy not to accept it.

Tonight I said "I accept" and bounced around the house for joy.

Dream Job

2007-02-22T19:31:00.000-05:00

I'm giddy. Yesterday, I got offered my dream job. It's in Tanzania, with a community-focused NGO, doing HIV prevention and care and treatment in 10 communities. It's like what I was doing before except with an HIV focus, more resources, more experience, and more autonomy. The organization has offices in the US, but they want the person in Tanzania to develop the programs and move the organization forward. So they're turning the reins over to me and putting faith into me that I won't ruin everything they have already worked so hard for. They say they're excited about me, but they can't be as excited as I am about them. It seems improbable that your whole life could change in the span of a few days. But it's perfect and I'm happy happy happy.

Super enough for the poor

2007-02-04T17:08:00.000-05:00

Anyone who has been overseas has had the disconcerting experience of seeing an Old Navy t shirt in a rural village, or running into a kid wearing a shirt from their hometown Y, or seeing a grown man wearing a shirt that says "World's Best Grandma". Most of these clothes are donated by private individuals, cleaned and baled in the sending country, shipped to importers in Africa, sold to entrepreneurs, and eventually sold to a developing country consumer.

Today there is a cute Super Bowl story about what happens to the Championship shirts and hats that are made for the Super Bowl team that ends up losing. World Vision gets it, to send overseas:

“Where these items go, the people don’t have electricity or running water,” said Jeff Fields, a corporate relations officer for World Vision. “They wouldn’t know who won the Super Bowl. They wouldn’t even know about football.”

This statement is true, and the people who receive it probably are grateful, but it typifies a side of charity that I hate. Logic like this justifies the types of donations we often received at the children's charity I worked for in Tanzania: women's high-heeled shoes, stained clothing, random puzzle pieces, broken trucks, dolls with missing limbs. Of course, we also received beautiful children's clothes and brand new toys and boxes of sharpened crayons, and of course, our kids were happy with those broken toys and scraps of puzzles. But whenever I opened a box that was full of garbage, I felt like our children were being disrespected.

In the case of healthcare, this same type of logic gets applied, and the consequences there are even more severe. Water projects are done on the cheap and break less than a year after donors have left. Refugees are given a ration so deficient in nutrients that they develop micronutrient-related diseases like scurvy and Ricketts (hey, otherwise they'd be starving, right?). And right now, throughout Africa, HIV-positive mothers are being given a drug to prevent transmission of the disease to their children that is only half effective and allows 15% of those newborns to be infected (more on this topic in a later post). We can do better than that, and we should.

Cheap Drugs

2007-01-29T21:37:00.000-05:00

The pharmaceutical company Novartis is testing India's new patent protection laws. India has a new law on patent protections in order to comply with World Trade Organizations regulations and Novartis is challenging the right of Indian companies to manufacture Gleevac, a drug for a rare form of leukemia.

Why should we care about legal maneuvering in India? Because Indian pharmaceutical companies are the primary source of generic drugs for countries in the developing world, from penicillin to antiretroviral drugs. Public health programs rely on these companies to produce affordable medicines for patients who can't afford them. Public pressure has prevented the WTO from cracking down on poor countries importing some of these drugs, but now working with India's national government it has imposed regulations that put millions of lives at risk.

Novartis is trotting out the same tired arguments that a) they need patent protections to ensure their ability to fund R&D and b) that it's not a matter of patient rights, but about "clarifying intellectual property rights ". a) is a half truth--companies benefit hugely from public funding and cheap drugs for the poor are clearly a public good, and these huge companies spend much more on marketing than they ever spend on R&D. b) is a semantic argument at best and a lie at worst. The companies want to protect their profits at the expense of sick people. If Novartis continues with the case, Indian judges will make a decision that could severely hamper public health in Africa. If you think they should drop it, you can sign an online petition here.

Different worlds

2007-01-23T22:37:00.000-05:00

The school of public health has six departments, each populated by people that look different from the others. In Epidemiology, they are casual and math-y; t-shirts, jeans and sneakers, all set off by an insulated lunch box. The Biostatisticians look like that, except more withdrawn and terrified. The Behavioral Sciences and Health Education crowd is mostly sorority girls, and a few guys that are secure enough in their masculinity to be the sensitive type. In Global Health, my department, we occasionally work our field clothes into daily wear--Chaco sandals, fleece zip-ups, knee-length skirts--but we also like to accessorize with trinkets and scarves from around the world. The Environmental Health types dress like they are ready to go clean out streambeds at any time. They carry enormous backpacks because they bring their lunches in tupperware, carry their nalgenes, and lug around their laptops so they never have to print anything out.

But the Health Policy and Management Department is my favorite, for looks. They all talk like they are from South Carolina and they dress either like JC Penney ads or like business school students. I've taken two classes in that department, and both times I thought I would develop allergies to blonde highlights and pearls. In my class with them today, we went around and said what we did over break. Several people had gone to college bowl games, others had gone to the beach in Mexico or the Carribean, one girl bragged about getting her mom drunk for the first time. For me, it was experiencing a new culture. When they are finished, most will enter the for-profit sector, where they will make comfortable livings in the "healthcare industry", enough to indulge their hobbies and college sports rivalries. I don't know where I'll be, but hopefully far from there.

Economics and AIDS

2007-01-19T22:52:00.000-05:00

On the front page of the University of Chicago's website (my alma mater), there is a link to a New York Times about Emily Oster, a fellow at the University working on HIV in Africa. Intrigued about such a prominent Emily working on HIV at Chicago, I read further. Apparently, Ms. Oster is an economist, and according to the news article, her work has established that poor people in Africa;

...had less of an incentive to practice safe sex...because many of them could not expect to reach old age, whether or not they contracted H.I.V. Any attack on AIDS should therefore include an attack on poverty.

Oh really? Phillip Setel, in his ethnography of changing sexual relationships in Northern Tanzania talked to women who were not using condoms. They told him that they understood the risk of AIDS, that they thought it very possible that their husbands had extramarital relationships, and they knew that using condoms would protect them, but that they had no way to communicate about safe sex with their husbands. He found that teenagers in the region had received many messages about safe sex, but had a highly specific set of relationships and didn't see the messages as applying to all of these relationships. In some countries, a history of biomedical abuses by the government has caused HIV messages to be viewed as politically motivated and therefore ignored. And anyone who has been to a place where AIDS has hit hardest knows that people understand the unique nature of the threat, and would not choose to die a painful and prolonged death.

Granted, the article provides a basic summary of her work, but it's exactly the type of thing that drives me crazy about economists, and particularly those that economics is the best way to explain absolutely everything. Economics can't usefully describe power structures or traditions or history or human terror. Reducing complicated human actions down to the equation of a cost-benefit analysis is not illuminating and is usually offensive. Ms. Oster's work both assumes and implies that people view their low life-expectancies in value-neutral terms, but that's not true. If you ask them, the poor say that their misery is excessive, the result of structural injustice. From defining their behavior as a simple logical responses to a given situation, Ms. Oster resolves to fight poverty as a technical response. A better analysis asks why these people live in poverty, and asks them what their constraints on behavior are to inform a community-based response. Poor people are people, not thought-experiment decision machines.

Where have I been?

2007-01-13T18:24:00.000-05:00

One of the reasons (though not the primary one) for my long absence from the blog, has been job applications. Right, trying to be gainfully employed for once, as of May 2007. Anyway, I wanted to share this personal statement. It has been constructively torn apart by some good friends, and the statement I submit will be very different. But it was a useful exercise for me, and I think it summarizes how I got where I am pretty nicely.

--
I have had many teachers on the subjects of poverty and injustice. Growing up white and wealthy in the suburbs, I had never thought much about it except in the abstract. I spent the July before my senior year of high school at a French language academy in a small town in Virginia. During one class on Francophone Africa, the teacher explained in broad outlines the complex and intertwined challenges that Africa faces. Somehow, in the 17 years of my life to that point, I had never even heard about the cycles of poverty, hunger and illness that characterize the lives of a majority of people on the continent. I was riveted.

As a college student at the University of Chicago, I took every class on international development that I could find. I was exposed to the indifferent logic of Chicago-style development economics, but I was also introduced to powerful critiques of this approach from the fields of ethics, human rights and anthropology. When I co-founded the school’s chapter of the Student Global AIDS Campaign, I learned from other students already engaged in global AIDS advocacy. They taught me how to advocate against the outrageous and immoral public health policies that were denying treatment to millions of people dying from HIV-related illnesses in the developing world. In books by Paul Farmer, I learned that challenging the status quo and putting the needs of the poorest and sickest people at the center of policy is a strategy that can create change, even for people living in the harshest conditions.

During two summers in college, and for a year after I graduated, I went to Africa, where I found even more teachers. My neighbors in Tanzania showed me what it means to wake up in the morning without sugar for your tea, much less medicine for your fever and money for your child’s school fees. The leader of the organization I worked for let me take up some of her duties and so I learned what it feels like to have a steady stream of people knocking at your door, each person with a story more heartbreaking than the one before, and each one of them asking you for help. I felt outrage as people I knew died of HIV, the promised drugs not yet delivered to the public hospital, but the Tanzanians around me were resigned. I learned that injustice can come to seem acceptable when it becomes the grinding routine.

These days I spend my time at the school of public health. I am learning in the classroom about HIV programs and public health approaches that are successful, and about programs that fail. I am learning how to count and measure and speak the language of donors. My classes on human rights and anthropology have offered a moral framework for evaluating these, and I have been engaging in advocacy about public health together with other students. But I learn the most two mornings a week, when I board a city bus to a homeless outreach center in downtown Atlanta. There, our guests teach me about what brutal injustices can be found mere miles from the comfortable house I rent. One client’s face was scarred from an aggressive bacterial infection that attacked him after he progressed to AIDS. While he was hospitalized, he was evicted from his apartment, and all his belongings thrown away. Today he lives a basic existence in a program for people living with HIV and dealing with mental illness as well, another victim of the intertwined injustices of illness and poverty in the richest country in the world.

What all these teachers taught me about injustice, is that it is worth fighting. Working side by side with Tanzanians who ignored their own poverty to serve other people, and providing services to people who are not being served by an unjust world order, is worthy and necessary. But what I have also learned about injustice is that it will never be enough merely to manage its effects. It must also be challenged at its source, by people with influence in solidarity with people who have none. That is, the policy that affects the lives of people living with HIV should be formed to fulfill the rights of those people, and advocates are the ones who must call for the fulfillment of rights. I want to be engaged in this struggle. I want to be a part of advocating for change and engaging in service both. I believe that what I have learned and experienced so far will allow me to contribute in a substantial way to creating change. And at the same time, I know that I also have a great deal more to learn.

Somalia

2007-01-09T17:54:00.000-05:00

Somalia has a window for peace, after 35+ years of civil war and rule by warlords. In recent years, a loose coalition of these warlords have received funding from the US as part of the War Against Terror, as this diverse group of brutal clan leaders portrayed itself as the enemy of Al Qaeda in Somalia. Of course, the daily terrors inflicted by these warlords on the Somali civilians who happened to cross their paths, were also being funded. And, not surprisingly, they didn't keep their promise to capture al Qaeda operatives, and bin Laden's associates have remained at large within Somalia's borders.

Somalia has an internationally recognized government which for most of the last year has ruled only its small capitol near the Kenyan border. It was a different group, the Islamic Courts, which swept the warlords out of the coastal city of Mogadishu and replaced daily chaos with peace. The allegiance of the Courts, and their stance on al Qaeda was unclear. But what was clear is that people in Mogadishu were glad to finally have peace in their streets.

The Islamic Courts are gone now. They were challenged by the recognized government, heavily supported by Ethiopian troops, and fled, the promised all-out war failing to erupt. Ethiopia has a large and advanced army, but its presence in Somalia is untenable, both for funding reasons and because Ethiopia is perceived as a Christian nation, and draws animosity in largely Muslim Somalia.

So what next? Donors and regional leaders are meeting to put together an African Union (AU) peacekeeping force, which would allow the Ethiopian troops to withdraw. Will the US under-fund this force, as it has the AU force in Darfur? Or will the US be a leader in stabilizing a country that is a former haven for terrorists and full of people desperate for stability and support from the outside world? The window is open, but it is small. Will peace come in?

A new drive

2006-09-22T11:34:00.000-05:00

So I gave up. Last year I really diligently and dutifully tried to use public transportation and walking and begging rides to get around Atlanta. And at the end of this summer, as I thought about the prospect of coming back to that life of endless frustration and humiliation, I just couldn't do it. So, reluctantly, regretfully, I bought a car. And I LOVE it.

The car is a 94 with 160,000 miles. It is surrounded with dents, has sticky locks, no horn, no aircon, no automatic anything, and a seatbelt warning sign that pings constantly. When I put gas into it, I have to pry open the little door, using my key as a lever. But I think it's perfect.

I still walk and take the bus to school, and during rush hour I still take the bus downtown. But in two weeks I've used the car to go to places I never would have gone to without it: to an Amnesty International meeting downtown, to the batting cage, to the grocery store, to visit a friend who was sick at home. As long as it runs for the year, it will have been completely worth it. I still think it's outrageous that public transportation is so bad in Atlanta, and it is just one more privilege of wealth that I was able to opt out of relying on it. But I love my car.

My baby.

2006-09-11T12:33:00.000-05:00

I am feeling hopeless about Darfur. An article in Sunday's NY Times (which provided the picture above) looks at a corner of the region where an internal displacement camp continues to receive new arrivals, although there is no water and no health care, and only a little food from the World Food Program. The African Union peacekeepers, ineffective as everyone knows they were, may leave, and government supported slaughter of the people in the camp is sure to follow. A UN peacekeeping force has been proposed, but the Sudanese government and citizens are rejecting it. An "invasion" by a European force could spark resistance, more bloodshed and then a premature pull-out. And then who will protect these displaced peasants already on the brink of survival?

I joined a local group that is advocating around the issue, because I was sick of doing nothing. The thing is, I don't even know what the US could do. It's the same way I felt about Iraq during the last election, or about the basketcase that is Zimbabwe. It's the most horrible thing I can imagine, and the only ones who could stop it are the same ones who are perpetuating violence. Destruction prevails again over human life, and all we can do is sit back and watch.

Slow progress in South Africa

2006-09-11T12:22:00.000-05:00

Mbeki's government in South Africa has responded to activists' and international scientists' demands to fire their erroneous and immoral health minister, by appointing a committee.

South Africa has an internationally influential activist community, spearheaded by the Treatment Action Campaign, which has been putting pressure on the government for years to provide real care for people with HIV. And, in many instances, they have been answered with half-truths about drug toxicities and outright lies about the power of natural remedies. It's an outrage, ongoing, and I hope the new committee is a sincere effort to hurry roll-out of antiretrovirals, and not just a strategy for political appeasement. 140,000 patients may be receiving ART, but millions more are waiting. For them, time is running out.

Clinton, redeemed?

2006-08-31T17:32:00.000-05:00

A few people sent me links to the NY times article on Bill Clinton and his foundation. The basic tone of the article is, sure, Clinton's doing a lot now, but he's probably just trying to make up for his lack of action on AIDS and Rwanda during his presidency and secure his place in history.

Can someone be forgiven for allowing a genocide unfold and millions of treatable patients to die? Clinton's line is that talk about redemption now won't save any lives. His foundation does, and his name and presence makes their work stronger and more impactful, which is why he is at the center of their activities. Public figures like him who enter the nonprofit worlds are vulnerable to their motives being questioned, but often one of the most powerful elements they bring (along with buckets of money) is their own star power, media coverage, influence and weight. Do they need a reason why?

2006-08-31T17:11:00.000-05:00

It's been 12 whole months since I started this blog up. I wasn't sure if I would be able to maintain it, but it's turned out to be very rewarding. For the next twelve months I will be trying to post more pictures, link to other blogs, and hopefully spread the word about this ridiculous thing. Anyways, thanks for a great year.

Epilogue: Australia

2006-08-24T11:55:00.000-05:00

So the epilogue to my summer in Kenya is two weeks in Australia with my parents, brother, and sister. We had a week in Sydney and explored the city thoroughly. We did the obvious, (opera house, harbor bridge), but also went to less famous neighborhoods and near-in suburbs by ferry. In Manly, we walked along the cliffs to enjoy the view of Sydney Harbor and from Watson Bay we looked out to the Pacific ocean. There is a beautiful botanical garden near the city center where my brother and I watched the sun set behind the Sydney skyline and were menaced by a flock of wild cockatoos. The city is world class, clean, and has excellent public transportation including buses, subway, monorail, and ferry. From Sydney, we did two day trips—one to the Blue Mountains, where we hiked through eucalyptus forest with enough palm trees and ferns to make it feel exotic. My brother, mother and I also went on a wine tour in an area that must be lovely once the leaves come out on the grapevines. We got tipsy and quadrupled our knowledge about wine, so it was a successful day.

It being my family, we also did a lot of very touristy stuff. We went to an animal park with all the Australian animals—including koalas (The Most Heart-Melting Creature on Earth), some overfed kangaroos, cassowaries (giant bird with a blue neck and a crest of horn on top of their heads), echidnas (egg-laying hedgehog with a little duck bill), and wombats (giant hamsters). I thought about how amazing it must have been for the European explorers when they first saw all of these improbable creatures. More touristy stuff: we rode two scenic railways and a sky gondola over a rainforest, and took a mangrove cruise. One day we signed up for a tour of a crocodile farm, thinking we would see some cute attack show or learn about habitats or something. Instead, we found ourselves on a tour of a working crocodile farm, supplier of skins to Gucci etc., with a very intense guide. In response to one of my stupid questions, he turned around, stared me down through his sunglasses, and asked: “Have you ever, in your entire life, been on any kind of farm at all?”. We giggled behind his back.

We spent a few days on Dunk Island, reached by a 20 minute flight in a tiny airplane from Cairns. The island was mostly covered with rainforest—palms and vines and ferns and butterflies fluttering through--but it also had a beach with a resort around it. Sea turtles poked their heads up from the waves. Being a family of participators, we alternated our beach lounging time with rainforest hikes, boomerang-throwing lessons, aqua aerobics, the sunset champagne cruise, and sea-kayaking. At night we ate nice dinners with wine in the dining hall, and then retired to our rooms to play bridge and Oh Hell until late at night.

We went snorkeling on the Great Barrier Reef twice. The first time we all got seasick, swallowed gallons of seawater, and didn’t see anything, but the second time was incredible. Even just floating on the surface, we could see dozens of different kinds of coral, anemone with clownfish darting in and out, huge parrotfish decorated in teal pink orange purple or yellow gray white or black, schools of tiny silver blue fish, and big sweet-lips with black speckles and stripes. It was just like an aquarium, except we were in it—we could feel the waves and hung out in one spot to watch a little cleaner fish tidying up a wriggling bigger fish. I wished I could watch for hours.

That was on the last day and on the boat ride back the afternoon sun was glinting off the ocean. It was the last beautiful thing I saw.

Hellos and Goodbyes in Kenya

2006-08-05T16:31:00.000-05:00

My last three weeks were a whirlwind. In Kisumu, I had to present my findings twice on powerpoint and once on a poster, produce 3 20-30 page reports, and whip up a protocol for a follow-on study. But after a grueling week, everything was wrapped up and ready to go. On my last day, a Saturday, Florence threw a big African-style party for me. The guests were invited to come at 4 pm, for dinner at 6 pm. The first guests arrived at 6 pm and dinner was served around 10 pm. At that point, the house was packed. Women and babies sat on the sofas around the TV—eyes riveted to a Mexican soap opera. The men had carried chairs onto the porch and sit drinking beers, talking mostly about the recently completed World Cup. The children raced upstairs and downstairs, spilling sodas, and climbing all over the guests. The dinner was spiced rice, mashed green bananas, ugali, grilled cheese sandwiches, taro root, guacamole, fried chicken, chicken stew, fried beef, beef stew, and minced meat sauce (you can spot my two contributions). I gave a short speech in Swahili and English thanking everyone—most of whom I’d never seen before—and we all ate until we were painfully full. Dessert was fruit salad served out of a hollowed-out pineapple by a lady who reminded me of that one person at every potluck who makes sure everyone has tried her casserole.

Having been appropriately farewelled, I headed to Arusha, where I used to live and work. When I got to the school, the kids came running, shouting my name. They were so excited to see me, they didn’t even ask for presents. My friend Genya, whose wedding I attended, now has a fat baby girl, my friend Zena is planning to get married, and two of my neighbors had newborns that they proudly brought me to hold. When I caught up with my old roommate Glory we both jumped around with joy. On the streets, people I didn’t recognize recognized me and remembered my name. But there were some sad developments as well. A woman whose husband I watched die of AIDS was pregnant. Some of our kids had left the school but were struggling at home. And these days in Arusha electricity is only being provided five days a week, a result of this year’s brutal drought.

While I was in Arusha, something amazing happened. When I was there before, I had been helping a boy, “Matatizo”, who needed a series of surgeries. But after the first surgery, his mother died and some of his relatives took him back to their village and since that time, there had been no word about his status (for more complete backstory, see: http://www.contextjournal.org/category1.php). But my first day back in Arusha, Matatizo and his relatives came to the school. Matatizo was much, much healthier than he had ever been—his limbs had plumped up and he could stand and walk for the first time in his life (he is 7). And the relatives clearly cared about him and they were ready to go ahead with the second surgery. So on my second day when I was supposed to be relaxing and hanging out with my friends, I went with them to Moshi. We learned that there is still no pediatric surgeon at that hospital (only two government hospitals in all of Tanzania have pediatric surgeons). But there is one at a private hospital in town and now we are trying to get the sponsor to agree to pay a little more for the second surgery for the private clinic.

My major activity while I was in Arusha, though, was helping to run a four-day “summer” camp. We had done a few of these before—basically we invite some of the needy kids from the neighborhood where we work to the main project site, and for a few days instead of 30 kids, we have 100. As far as I can tell, the work increases exponentially with each additional kid you add. The weather contributed four days of chilling rain, and the extreme workload brought out tensions in the staff and volunteers. There were a few times when I questioned the logic of me allocating time and money so that I could be present to peel potatoes, sweep the floor, wash muddy feet, and try to convince the volunteers that fingerpaints with a hundred kids was not a good idea. But some of the kids from the neighborhood are so skinny and their joy is so apparent at even a sticker or a tennis ball, that even though everyone is exhausted and the place is a wreck at the end of four days, it always seems worth it.

And the fact is, I missed it all the next week when I was back in Nairobi, producing reports and trying to impress people, only leaving my desk to microwave my lunch. I was antsy and ready to be done. Fortunately, I was housed very comfortably with the family of the lady I was working for. And now I’m off to Austalia, to meet my family and be a tourist.

Congratulations Andrew!

2006-08-05T10:08:00.000-05:00

You always do amaze me...

http://www.pokerpages.com/tournament/result13635.htm

Chuk on superheroes and global development

2006-08-01T11:10:00.000-05:00

well the thing about being a high priced ex-pat consultant, is that u always got that as a backup. i admired storm for leaving africa to go fight global evil, but im also concerned about what kind of super villains were running somalia by that time! let alone fuckin congo.. damn. they were gonna make a Spider Man India, but I just dont see what buildings he would swing between, u know?

Advice from Chuk

2006-08-01T11:04:00.000-05:00

So I've been a bit lazy with the blog, but when I put together my next real post, you'll see why. I wanted to share wise words from my friend Chuk, who is one of the most interesting people I know.

My question:

The people here at CDC like what I've been doing and now they're asking me if I want to think about coming back and doing a more formal job of it. Which made me feel good about myself. But then I realized that that would mean that I would be high-priced ex-pat consultant, and I don't believe in those. It would be pretty embarrassing to become one as soon as I finish school. I'm beginning to realize that I'm in kind of a Catch-22 because the big players in antiretroviral therapy for HIV are all the big donors and NGOs, which I don't think are good models for development/effective vehicles for personal action. But I also know that you can't make as much of a difference scraping along with some little NGO. Or, that I personally couldn't make much difference. What I need is a job with a big organization that is ethically in the clear. I can think of two. I hope they're hiring next May.

Chuk's Answer:

so when u work for a bigtime job cuz u figure u gotta get paid, u just gotta figure out how who does that right, and i bet the answer is to get with a small time NGO and make it get big, and then u will believe that it is working out well, like the parenting thing where time invested creates love (u know this bit from the little prince, when the prince is said he has spent so long with a flower he thot unique, but turned out to be just a common rose, he happens upon a fox who says to him,

"To me, you are still nothing more than a little boy who is just like a hundred thousand other little boys. And I have no need of you. And you, on your part, have no need of me. To you, I am nothing more than a fox like a hundred thousand other foxes. But if you tame me, then we shall need each other. To me, you will be unique in all the world. To you, I shall be unique in all the world..."

so the boy spends some time with the fox, and when eventually they find they must part ways, the fox tells the boy his secret,

"It is the time you have wasted for your rose that makes your rose so important")

so the NGOs u see and dont like are not yours and if u were with one and you believed in it i think that could be something that worked, not just this guerrilla strategy of always coming on board for small, underfunded groups, but instead making the little good ideas into big good ideas.

Letters to Sam, Part II

2006-07-18T05:00:00.000-05:00

Sam’s words next to arrows, my responses underneath. Omissions marked with ellipses.

> So, first, I think you're merging a lot of what I said with a lot of
> other arguments which I'm not making (or not trying to make,
> anyway). I'm not saying that our entire strategy should be to
> concentrate on making good arguments,or to focus on macroeconomic
> stuff. I'm saying that both of these need to be part of the
> strategy, and that it's a mistake to leave them out just because
> you're not seeing them as particularly effective. First of all,
> they're difficult to measure -- they kind of form the baseline for
> all other forms of action. I think that you'd see the world in a far
> worse place today if NOT for, especially, the huge economic
> incentives, etc. And I'm not going to be able to justify this based
> on any concrete examples; I'm at a huge disadvantage here. By
> showing failures of specific programs which try to help economically
> (rather than taking the health problem head-on), you're mentioning a
> lot of specific programs which were set up foolishly. I don't think
> that this speaks in any way to whether the approach in general is a
> good one; it's akin to "sex education is foolish because teaching
> children about abstinence has not decreased AIDS transmission." I
> never made the argument that we should be subsidising American
> farmers as a way to affect hunger in Africa, and I never asked for
> the "status quo".

You are saying that we have to maintain our credibility by making "good" arguments or no one with money is ever going to listen to us. That's what I'm responding to. I think a lot of development-as-usual projects are worse than ineffective: in the case of food aid and a lot of economic development projects (sweatshops, environmentally destructive "development" projects), they're actively detrimental. And the programs I was talking about are not "set up foolishly"; my point is that they're exactly the type of programs you will always get if you a) wait for the interests of the powerful to coincide with the needs of the poor and b) think that because people are poor, actions to promote their well-being should be held to a low standard.

Your argument is that as advocates we not make higher-order, "unreasonable" demands on the powerful because it destroys our credibility. Our strategy under your plan, therefore, would be to only advocate for the most feasible interventions and those that are most likely to line up with what the rich feel like doing. My argument is that as advocates we should work in the near-term for progressive realization of what we want but do it in the broader framework of a call for social justice which includes all the stuff that is in all those meaningless UN declarations which I already conceded should not necessarily be called rights. But, I still think we need some framework that puts those economic/social considerations, and the interests of the poor, at the forefront.

My argument was that, merely because a strategy is
> mis-used, we shouldn't necessarily scrap the strategy; not that we
> must pursue that strategy to the exclusion of others, or that we
> should blindly follow an existing, failed structure. As this whole
> practice of throwing our economic weight around to micromanage living
> crises is incredibly new (at least to me, it seems like it's only 20
> years old at most), it's natural that we haven't gotten it right.
> Even I can clearly see problems with implementation, but I feel that
> abandoning these overall strategies because they have not yet been
> effective (btw, see my other favorite argument that NO program is
> ever going to be effective unless it's subject to invasive monitoring
> and the proper incentives for performance) is almost the same as
> saying "well, Africa isn't helped much by MONEY, clearly, so let's
> try the approach of withdrawing all foreign aid." (analogies don't
> work as well when they're on the same general topic, but I hope that
> made sense) I don't know enough to state with any certainty that
> economic measures have been ineffective because they have been
> haphazardly organized and trivial in scale next to what would be
> necessary, but I strongly suspect that this is their primary failing,
> for which the measures themselves shouldn't be blamed.

I'm not arguing against the strategies, I'm arguing against the logic that underpins them and results in the bad strategies being chosen and their implementation being so lame. If we sat down and looked at it and the status quo was really the best way to help the poor _regardless of the interests of the rich and powerful_ then I would advocate for it loud and lustily. What I am saying is that we need a framework for policymaking that makes it possible to pick strategies that actually help people instead of the current framework, which I argue, doesn't.

…The status quo is the last thing I'd ever argue for in
> just about any field, except possibly in French cooking, where people
> always screw it up when they try to modernize it. My entire point is
> a baby/bathwater one. In this particular way, I _do_ think you're
> … lumping a whole series of
> arguments together because they are occasionally made together and
> then attacking one in that group based on the insufficiency of
> others. Which is kind of the point I was trying to make with re-
> defining the question. It's not that looking at a problem in a
> different way is bad, it's that it's not addressing the question
> under consideration.
>
> [re-defining] "Public health experts recommended putting all the
> focus on prevention of HIV and treatment of opportunistic
> infections. ... Partners in Health started treating people with
> antiretrovirals at their clinic in Haiti and they showed that they
> could get high adherence rates and that people got better, and they
> did it despite the 'riptide of cost-effectiveness arguments'"
>
> That's not re-defining the question, though, that's challenging an
> assumption made by 'experts'. By re-defining the question, I'm
> talking about an argumentative (does that have two meanings? I mean
> 'relating to argument') tactic. I don't think anyone is more
> skeptical of 'experts' than I am; I think every field benefits by
> challenging the idiocy of the current way of thinking of things. I
> was trying to make the point (no doubt ineffectively) that it doesn't
> really make ANY point if you fail to address the one on the table --
> someone can always re-define a point away. (I like the example of
> the second-to-last panel in the last comic strip of this link: http://
> www.doonesbury.com/strip/oldglory.html ) I'm not in any way trying
> to say "don't challenge how things are being done."

Look farther up in that paragraph. Before advocates got involved it was all about how to manage and prevent HIV in Africa--we said that that was a ridiculous way to frame the problem when treatment existed. Okay, it's not as fundamental as asking "so why is Africa so devastatingly hit?" but it's an example of how reframing the public debate made stronger action possible.

And I don’t see any reason why asking the big questions is incompatible with taking immediate action. That's why you work for progressive realization + long-term vision. Like the organization I worked for in Tanzania. We understood that the children we were serving were suffering because of a lot of huge forces—history, social breakdown, growing inequality within their country, corruption, etc. and we understood that we weren’t providing them with the services that they deserved. But we saw that it was valuable for us to do what we could to make their lives better. I don’t really plan to spend the rest of my career moping around how global inequality is so terrible and unfair; we have to do what we can, but do it within a framework that makes it possible for the poor to get out from the bottom of the pile.

>…
> "I'm really against this idea that we should set a bare minimum and
> make sure that we achieve that and then in some rational future
> moveon to the next order of business."
>
> That's exactly what I'm arguing against. I don't think you CAN move
> on later and re-define the scope of rights. But again, you're
> equating rights and things we think are good. And I grant you that,
> within the Public Health and Human Rights arenas, the word has been
> largely re-defined beyond anything I would have thought of as a right
> -- perhaps to the point that we're actually thinking of different
> meanings. I just don't see something as a right merely because I
> believe someone deserves it, or because it's owed to someone. I
> think every government has the absolute, unquestionable duty to care
> for the poor and the sick; I think these are more important functions
> than guaranteeing the free practice of religion, but I don't think
> that their importance makes them "rights".
…
> OK, here's the point I'm trying to make in everything: we have to
> have levels of principles, each of which trumps the one before it, or
> everything becomes situational and pointless. I like the metaphor of
> the laws and the constitution… Like laws which we'd
> like to make, but which conflict with higher goals (I'd like to
> outlaw the Chicken Caesar Salad, but I know that would be wrong, even
> though that specific law would undoubtedly make the world a better
> place), I believe that rights are something not to monkey with out of
> a desire for a result, and I believe that disingenuous arguments are
> bad even if they are convincing, effective, and improve people's
> lives. The ends can't justify the means in a policy sense, ever. I
> think that's just about the most important principle on earth, maybe
> even outranking "be nice to each other".

I feel you, my brother. I understand your arguments. But I don't agree. Ends matter and the people who control the means have their eyes on the ends, so we have to too.

Letters to Sam

2006-07-16T06:49:00.000-05:00

I've been having an interesting email exchange with my friend, "Sam". "Sam" has been thinking a lot about human rights and global justice lately, and agreed to let me excerpt her emails anonymously, and my response. I marked deletions with ellipses.

Sam says;

My basic point about the Human Rights world is that it trivializes
some of the most important issues on earth....It's like the "15
billion women are beaten every minute" campaigns. You exaggerate a
real threat, or you make it too sensational, and it hurts the
credibility of everyone addressing it, and it kills your own. If
it's something that's bad, the simple facts stand on their own better
than overblowing them. It's totally irrelevant that people who
already agree with you are "shocked, horrified"; it's incredibly
relevant that it turns off one person who is generally suspicious of
"liberal" claims…

There's the whole argument about subsantive vs. aspirational rights,
or civil/political vs. economic/social, or first-generation vs.
second-generation, or negative vs. positive, which are all basically
the same thing, and one which I could have for months… Of course, I think that this is a re-definition of the word "right" to begin with; there's something
questionable about the logic of a right which isn't actually
exercised anywhere, and something even more questionable about the
idea of a "right" which can't be defined (aspirational rights). So,
first, we're saying that the right to be free of cruel punishment is
on par with the right to organize a labor union... who genuinely
believes this? Second, if we re-define "right" as something we
really, really WANT everyone to have, it loses its meaning entirely.
Third, if we WANT something to happen, the worst possible strategy is
to concentrate efforts on toothless demagoguery, trying to attain
some sort of moral high ground -- fine, so we've gotten a bunch of
countries/people to agree, despite the fact that they don't really
BELIEVE it, that something is unassailably correct; now we can start
the work that we actually intended in the first place, but with the
huge moral force of a bunch of countries merely paying lip service to
something?

Concentrating on a "rights" framework seems to me the ultimate in
wasted effort. Generally, I prefer the long-term game in trying to
attack huge issues. But creating documents by which no one feels
morally bound devalues the power of treaties in general and causes
people to start distrusting international institutions which depend
entirely on universal acceptance. I've come through this
international law thing with a deep skepticism of the UN. If I have
reversed course this much, you can bet that there's not a prayer in
the world for the UN, or any of its bodies, gaining any moral force
with any of the world who was already suspicious. People lump
themselves easily into camps, and this is driving people in droves
into the Bush camp. Hell, they make better arguments these days;
their conclusions may be wrong, and their logic may be disingenuous,
but it's become less disingenuous than the logic on the left, because
we've stopped even trying to be logical. We're hell-bent on making
an absolutist point, and going for the emotionally appealing image,
and exactly the sort of fear-mongering, alarmist, irresponsible crap
that they've always accused us of (wrongly, in the past, rightly now)
in the first place. And I think this all boils down to righteous
indignation and the unwillingness to be self-critical.

…I guess my
point is that the people on the "right" side end up doing more damage
to their cause by ineffectively pursuing it than people on the
"wrong" side do through direct attacks.

You re-frame the question as "why are resources for the health of
poor people limited?". I think that this is one of those arguments
which is best made as a separate point entirely from the ideas of
cost-effectiveness and sustainability, etc. Sure, these buzzwords
are largely crap. But I think that cost-effectiveness IS an
important point, because our resources ARE limited -- and not just
for poor people. And our resources will always be limited, no matter
how much we change things. So, yeah, your question is more
important, but it defines away the nitty-gritty as irrelevant by
asking that it be answered first. … I think that re-defining the question is
one of those things that, while it may make the most sense, detracts
from the force of an argument. NOT that I'm claiming you shouldn't
use that when talking to me; please don't take it that way. But I
think it's the surest way for the good guys to lose an argument in
the public arena, because it's been over-used to the point of
absurdity…

Emily says;

…I understand the arguments you are making about strategy in the field of
international advocacy for the shafted. And I think we do agree on
the fundamentals, like that the public health/UN infrastructures are
part of the same system that puts people in such a bad position. And that overclaiming
dangers/tragedies/outrages is counter-productive, particularly at the
point where everything is so fucked up already. I'm pretty agnostic
on the rights thing, and pretty uneducated about it…but maybe will make a
tepid argument for them below. And obviously I agree that we have to
work with the big jerks of the world and get them on our side. Oh, and
I agree that protesting globalization or the WTO as a whole is dumb.

But I still fundamentally disagree with the idea that our strategy as advocates
should be to spend
all our time making good arguments, to get the people with the money
"to sway slightly in an egalitarian /
altruistic kinda way", presumably, when being egalitarian/altruistic
happens to line up with their own interests. You're making an
effectiveness argument, but I just don't see any evidence that that
strategy has been effective in making people's lives substantially
better. To me, your strategy is the status quo—people doing good when
it suits them, not when it doesn't—and not only does it result in a
lot of direct screwing, like unfair international trade rules,
predatory investment, child sexual exploitiation, but it also results
in a lot of really ineffective aid. So when there is famine in Niger
we pay American farmers a fair price for corn, pay an American
shipping company a no-bid rate to ship it, and 6 months later, after
the rains have come and the farmers have harvested, a whole lot of
free corn arrives and screws up the market, setting people up for next
year's famine. And the thing is, that's the kind of aid we feel good
about.

I would argue that at its most benign, what your strategy gets us is a
lot of donor-driven, vertical programs that may have a moderate impact
wherever they are targeted, but that end up either straining or
undermining the government and other aid projects in the area…

You say that "re-defining the question is
one of those things that, while it may make the most sense, detracts
from the force of an argument" but I think HIV treatment is a perfect
counter-example. As advocates, people told us we were impractical for
asking the question, "Why should tens of millions of people infected
with HIV be sentenced to die when treatment exists?" 8 years ago, the
head administrator for USAID told reporters that antiretroviral
therapy would never be feasible in Africa because Africans can't tell
time. Public health experts recommended putting all the focus on
prevention of HIV and treatment of opportunistic infections. But
those tens of millions of people were beyond the point of prevention,
and when you have HIV, treatment of OIs only makes you feel a little
better and then you die. Partners in Health started treating people
with antiretrovirals at their clinic in Haiti and they showed that
they could get high adherence rates and that people got better, and
they did it despite the "riptide of cost-effectiveness arguments"
(that's Paul Farmer, my hero). Other advocates used that evidence to
make their arguments and now, just a few years later, there are
literally billions of dollars for HIV treatment for poor people. If
we as advocates had spent all our energy asking for palliative care
for sick people and jumpropes for orphans, that's what we would have
gotten, and Bush would have been just as self-congratulatory as he is
now; it would have been just as much in his interest as the money he
put up for antiretroviral therapy.

That logic also justifies supporting a lot of really bad policies.
Food aid in the status quo is just one example, but so are malaria programs
that provide cheap drugs in regions where the malaria is already
resistant to the cheap drugs. I want to give an example from the
research I am working on. So, right now for the prevention of mother
to child transmission of HIV in Africa, they are implementing 2-dose
nevirapine. The mother takes a pill when she goes into labor and the
baby gets a dose within 72 hours of both. It's cheap and it's easy
for the mothers to do themselves, and when implemented properly, it
cuts the rate of transmission during delivery in about half. But in
the US and other developed countries, the standard of care for years
has been a short course of combination antiretrovirals or at least AZT
for a month before delivery. This is harder to do, and it's more
expensive, but mother to child transmission in the US is now virtually
0. So what should our strategy be? Should we be scaling up the easy
intervention because it is the most feasible and realistic and be
satisfied that even if we had 100% coverage about 30% of the babies
will still get infected? Or should we be working to provide African
mothers with the same standard of care that American mothers have been
enjoying for years? I don't think that asking that question
undermines the current program, and I think it provides a better
direction for the future.

And I don't think a more expansive/fundamental view is impossible
because I think we are seeing a change in the way the public debate is
framed now. Look at Warren Buffet—he didn't give 34.7 billion dollars
to one of [those] business-as-usual
NGOs; he gave it to Gates because they are one of the organizations
that can actually change the world because they are willing to invest
in what critics say is impractical or too expensive.

I think it is more effective to advocate for what we want in the long
run, and negotiate for what is required in the meantime. So let's not
limit ourselves to saying that we want everyone in Kenya to get a
grade 6 education, let's say that everyone deserves access to a
complete education and start with the primary schools. It's true that
we need money to do what we want to do, but that is in the short term.
If we don't have and push our long-term vision, whose plans for the
future will prevail.

You say, "If we re-define "right" as something we
really, really WANT everyone to have, it loses its meaning entirely."

I just don't see why. ...Just because children don't have schools to go to
doesn't mean they don't have a right to education, or because there
are no hospitals, women don't have the right to give birth safely.
I'm really against this idea that we should set a bare minimum and
make sure that we achieve that and then in some rational future move
on to the next order of business. There's no waiting for some day
when no one is being tortured so we can start talking about housing.
Let's not confuse advocacy and declarations with action (ahem, UN) but
let's build our policy now around a set of ideals for the long-term
future… South Africa's model is "progressive realization of rights" or something like that, and I think that's what I'm for.

My Blood

2006-07-06T05:41:00.000-05:00

I'm always getting disqualified for donating blood in the US for silly reasons; for being anemic, for having a cold. I've been summarily dismissed the last few years for having spent too much time in Africa, which apparently puts me into some kind of relatively high risk group for HIV.

Here in Western Kenya, I am in a relatively low risk group, but when I tried to donate today on my lunch break (at the state of the art transfusion center that shares our compound), I was rejected again. This time it was my malaria prophylaxis, but the lady was nice about it: "Come back and donate sometime when you are not on drugs."

Kenya Stand the Excitement?

2006-07-04T05:49:00.000-05:00

I would like to take this opportunity to introduce the cast of characters at the house where I am staying. There is Florence, my “host mother” (she is only 27), who has a bubbly laugh and is very fun-loving. There is Peter, the father of the house, who is a nice guy who spends a lot of time making exasperated sounds at the TV news. The oldest child is seven-year old Sandra, who is quiet and sweet and falls asleep like a person falling off a cliff. There is her younger brother, Francis, who everyone calls Uncle. He is a typical active 5 year old boy who can often be seen kicking a soccer ball around the house, putting his fingers in the communal food dishes, throwing trash on the floor, rifling through my things, yelling, and being told to stop whatever he is doing. In addition to the nuclear family, there is the housekeeper from the village; there is Evelyn, a 14 year old girl who goes to school during the day and does huge amounts of housework in the evening (she is somehow related to somebody in the house); there is Odipo, another relative, who is a student about my age whose spine is twisted into knots by a case of childhood polio. Then there is a rotating cast of 1-3 other unknown relations who appear for some reason, stay for a few days, and then leave without notice.

The 9+ of us sleep in three bedrooms with four beds total, we gather around the table for dinner and make the kids share chairs with adults, we swat mosquitoes in the evening, take turns playing soccer with Uncle, watch World Cup games, laugh, make noise, and sometimes get angry at each other. At times I get a little jealous of my friends here who have their own rooms and get to go to sleep when they want to, eat what they want to, and avoid the minor eruptions that take place whenever people live in close quarters with each other. But overall, I feel very lucky to have been invited to share the life of this family, and I find that I grow more tolerant of the annoying parts over time, not less.

The work is going great, and if anything I am overwhelmed by how much more I am going to be able to do than I expected. I spent a week in the big hospital in the relaxed town of Kisii, poring through reams and reams of inconsistently kept, handwritten patient registers. I can’t say that the large amounts of data entry this project requires are particularly thrilling, but I do get some geeky kicks out of what the analysis is turning up. I have to make a 10 minute presentation of it all in about two weeks, in addition to a clutch of reports, so I’m feeling pressure to figure it all out and boil it down quickly.

But, the real fun has been on the weekends. Two weeks ago two friends and I woke up late one Saturday in Homa Bay and headed for Homa Hills. This task was complicated by the fact that we had missed the morning’s boat and the once daily minivan, so we hung out by the water’s edge until somebody gave us a reasonable price to get across the bay to where the hills loomed. The boat dropped us on a shore where people were washing their dishes and their children in the lake’s water. We started up the only road, passing nothing but farms and fields and friendly people carrying water, firewood, babies. With every step, the view was more beautiful, as we could see more of the silvery lake, ringed with pale blue hills, more of the fields we had already passed, more of the red road snaking behind. Eventually we decided to turn off the main road to head up the steep part of the hill. We asked around and started up a path between the fields, which we lost, then found, then lost again. As we were trying to figure out which way to try next, a very pregnant woman came scampering up and proceeded to lead us up the hill, on what might have been a path if the millet hadn’t been fully grown and ready to harvest. As it was, it took a lot of crashing around and picking our way through downed stalks until we came out on a little hump that brought us the most beautiful view yet of the fields, the silver bay, and the mountains in the distance. Much farther up the hillside, children tending herds of animals whooped and yelled to each other.

Then this last weekend, five of us went to Kakamega Forest, a national preserve that protects some of the last remnants of the rainforest that used to stretch across the country. After an irritating hassle at the gate, we were immediately mollified when a red-tailed monkey crashed through the trees above our heads. We spent the next two days wandering the forest’s trails, marveling at iridescent butterflies, enormous snails, strange birdcalls, troops of colobus, red-tailed, and blue monkeys. Despite our combined intellectual prowess, we did not plan well for the afternoon rainshower and ended up running around looking for our cabin in the midst of a soaking storm, with two umbrellas and one jacket between us. On the second day, we woke up while it was still dark and charged up a hill with a lookout tower. As the sun came up, mist moved through the trees, birds and monkeys called, and we could even hear drums from a church in a neighboring village. I was overwhelmed. The guide told us about all the amazing and wonderful species of animals that the forest kept well-hidden; he told us that the two little snakes we had spotted the day before were about the deadliest in the world (10 minutes, he said, and you can see your leg disintegrating; 20 minutes and you’re dead) and on our way back to the cabin, he identified two sets of tracks: serval cat and pangolin (worth looking up).

Later that morning, we missed a turn and ended up on a six hour hike through the dripping forest, with little food or water and less than 100% certainty that we were heading out of the forest and not deep into a neighboring preserve. At our tiredest and most footsore, after we finally found our way and were trudging up a long murderous hill, we came upon a troop of baboons, which included a tiny baby with its ears sticking out, who looked back at us calmly before moving into the trees. Fortunately, I was with a group of three guys (our fifth companion left the day before) who kept laughing throughout the whole ordeal, and even held up well when our ride to town from the park gate ended up being a school bus carrying an entire, very excited, girls soccer team. For once, I was not the star attraction. Despite the fact that every time I spend a day with these guys, I miss lunch, have to share my water, and end the day sore, scratched, sweaty, filthy, and usually bleeding, and despite the fact that they chose to wake me up for our sunrise hike with a farting contest, it has been on our adventures that I have felt the most alive and the most like myself.

I know that I am here to work on HIV and to learn about health care, and doing that has been rewarding in many ways, but this country is beautiful end to end and I wish I had time to see every part of it. I guess it’s a beautiful dilemma—feeling overwhelmed by all the amazing things you wish you could be doing at once.

2006-07-04T03:35:00.000-05:00

One of the Wise Old Guys of public health, who addressed us early in our first year, reminded us to always see "the faces behind the graphs". I was crunching numbers just now and got one, .208, that made me pause. For the average woman who attends antenatal care at one of the nearby district hospitals, who is 25 years old and 27 weeks pregnant, who is thinking about the new life inside of her, and the changes in life ahead of her, who agrees to a simple HIV test in addition to her height, weight, and blood pressure, who sits across from the white-suited nurse and waits for the test results to show, that is the probability of receiving a death sentence, the probability that the drop of blood from her fingertip will turn the test positive. The calculator clicked, and I saw her face.

The News

2006-06-29T10:20:00.000-05:00

Every morning, as I leave the “estate”, I pass a newspaper seller, who spreads the day's papers out on a burlap sack and pins them down with stones. There is always a group of people crowded around, reading the headlines of the 5 English-language dailies, and occasionally forking out a few shillings to walk away with a copy of the day’s news. At my house, the TV is tuned to the BBC news round up in the morning, Swahili News at 7 and the English News at 9 without fail. Dominating the news since I arrived has been the case of the Artur brothers, two Armenians who were hastily deported after some sort of showdown at the airport, but who may be recalled to testify before a congressional commission if a presidential commission doesn’t declare the congressional commission unconstitutional because the president’s office may have been a little too buddy buddy with the Armenians who may or may not be arms traffickers and who may or may not come back anyway so that one of them can marry the Kenyan love of his life. I think.

In Tanzania, the Swahili papers were primarily gory photos of bus accidents, tabloid photos of girls in small outfits acting sloppy, and accusations of witchcraft between the two best soccer teams. The English language paper was almost unreadable and certainly did little to advance public interest. Here, the papers are mostly dominated by political news, but they also publish Reuter’s reports from around Africa, and have pretty intelligent editorials and even some arts and living pullouts and kids’ sections. The television news is decent too, even doing stories on the plights of some of the poorest communities who have been displaced by development or, in the northwest, by conflict.

The most exciting thing about the news here is that everyone is engaged, and you can hear people arguing politics in every public place. I get the sense that everyone is fed up with corrupt and self-serving leaders, and tired of living in a dysfunctional country as a result of it. And they are certainly willing to say so. Five years ago, Kenyans were living under a blatantly corrupt ruler finishing his 25th year in office and this month the members of parliament had to cut back some of the benefits they had lavished on themselves. Now, will Kenyans be able to translate their outrage into action to fundamentally change the way their government works? I am excited to find out.

Any other names

2006-06-21T10:27:00.000-05:00

I wrote previously about the Kikuyu system of naming, but I recently learned about the Luo system for last names, which I think is even better because it is completely random. Basically, you get your last name based on what time of day you were born. I’m not up on the literature, so I don’t know if being born at certain times runs in families, but essentially, if you were born in the afternoon you get a certain last name, and if your sister was born late at night, she gets a different one. If you are a girl, it starts with a, but if you are a boy it starts with o, and that’s it.

First names are funny too; most of them are Anglo but pretty old-fashioned so that all the women sound like 1950s housewives—Phyllis, Eunice, Gladys, and Beatrice are all popular. I wonder if these are the names that missionaries and colonists had and handed out, and what happened to the names that babies used to get.

Traveling companions

2006-06-21T10:17:00.000-05:00

I have a small confession to make. During the school year, I used to get annoyed when I would hear that yet another person from my school was also going to be in Kenya, and when they would talk about meeting up or traveling around, I would sort of yeah, whatever them and think to myself that I would be much too hip to the East Africa thing and much too busy with my work and with spending time to Kenyans to spend time hanging out with them.

But that was stupid. I forgot how when you’re in a foreign country you want to see everything and go everywhere. And I forgot how much more fun it is to see things with other people who are also excited to be in the country and also excited to see things. And most of all, I forgot how cool the people I go to school with are. So here’s a picture of me with some of the cool people I am lucky to get to hang out with this summer.

Heard from a hill in Homa Bay

2006-06-21T09:53:00.000-05:00

The first hill we climbed, and the town of Homa Bay.

It is Sunday, a day off, so a group of us goes exploring around the town of Homa Bay. The town has these steep hills like the tips of volcanoes poking through the earth, so we clamber up one. On top we catch our breaths, sweat drying in the breeze, and we take in the panorama. It is a great view, with Lake Victoria shimmering silver, green shores in a haze in the distance. At our feet are the rusting roofs of houses in Homa Bay and to the West, neat, green fields as far as the eye can see. We also spot another hill, right on the water, that looks like it will have a great view of the lake.

We guess our way to the base and then ask a lady selling tomatoes how to get up. The path is gravelly and slippery, and occasionally weaves around places where big boulders have been scooped out. The bushes eventually get too thick and too thorny for me and I sit in the shade as my companions brave the jungle to the top. At the base of the hill a husband and wife are working. He breaks the boulders from the hill into appropriate sized stones for building—chink chink chink—and she carries the stones down the hill in a burlap bag on her head. It is noon on Sunday, and as we sweat and suffer for the exercise and for the view, this is what they are doing.

A brown and white sheep wanders by. Near me on the hill, I hear her bleating, the clicks of grasshoppers, chirping birds, and the sounds of the rock breaker. From below, the sounds of life waft up—rumbling trucks, babies crying, roosters crowing, and the dueling loudspeakers of a chanting imam and a fire and brimstone preacher. The lake, to my right and behind the hill, is silent, mute dhows plying its surface. Also silent, sorghum ripening in the field, the dogs asleep in the shade, the red dust rising, and butterflies, which have overrun the town of Homa Bay.

A girl thing?

2006-06-21T09:48:00.000-05:00

So I’ve been having this ongoing conversation with different people about the gender ratio in Kenya. On several occasions, I have been informed that there are four women for every man in Kenya. This has been repeated to me by uneducated and educated Kenyans and even by one American expatriate. I have heard it expressed as a percent, I have heard supporting information (i.e. that 75% of newborns are female) and everyone I have talked to insists that it is true, though no one can explain why it would be. I am willing to buy that men die more quickly here of HIV and from violence and accidents, and I think it might even be possible that women outnumber men, particularly in the older age brackets. But if an entire nation were so dramatically skewed, I promise you, the world would be hearing about it. If girls were being born three times more frequently than boys, we would know about it. As it is, in Kisumu town, men are everywhere, most of them zipping around or lounging on bicycle taxis, offering to take you anywhere in town for 15 cents.

Having this conversation, though, and appreciating the persistence of that particular statistic has made me wonder about some of the myths we pass around in America. That people of different races all have equal opportunities might be one of them, that being thin denotes being healthy, that children raised in non-nuclear families are inherently worse off, that our government is an expression of the will of the people. I’m sure there are others—the lies that stick in peoples minds and mouths despite all evidence that contradicts them.

At last! Pictures!

2006-06-12T10:25:00.000-05:00

Well, this is all I could eke out from the internet connection, I'll try to post more later.

Fields near Nyamira.

Kisumu town at dawn.

Dancing the Hungula

2006-06-12T06:13:00.000-05:00

To dance the Hungula, first you have to find where a band is playing. Electric keyboard, drums, shakers, a clanging metal ring, and vocals sung through enormous, low-quality speakers. Then you watch them warm up, playing songs with no vocals as you sip your soda or your beer. Then, once the singer takes the stage, and the crowd gets big enough, and you, being the only white person there, get your nerve up, you’re ready for the dance floor.

So you bend your arms at the elbow and flap them up and down or move them like you’re running, but keep your shoulders pretty still. The step, if you choose to do one at all, is left-right-left-right and you can do it on every beat or every other beat, or some combination thereof. Then you move your hips, as much or as little as you want, and you’re dancing the Hungula! You can dance by yourself, or in a group, or with a partner. Your Luo counterparts laugh at the lyrics to the songs and point out the other people you are dancing with—politicians, prostitutes, and other scandalous personalities of Kisumu’s elite. The old guys have big bellies but still like to gyrate like salamanders, and the married women dance with each other, looking respectable. The women have all had their hair done, but their clothes range from T-shirts and jeans to evening wear with sequins. The men wear loud shirts and pants that balloon at the hip and taper at the ankle. It’s raucous but relaxed, a great form of exercise, and a very fun evening.

Kicks in Kenya

2006-06-10T04:17:00.000-05:00

My time in Kenya so far has been a week-by-week progression from big city to medium town to small town. I started in Nairobi, a city where crime is so pervasive (or the fear of it is, at least), that I found myself shuttled from guarded enclave to guarded enclave—CDC office, my friend's hotel, expat-frequented restaurants. It was hard to get my bearings and hard to feel like I was somewhere new. My first Sunday I got to tag along with a Kenyan family as they went to their family farm just outside the city. It was a special occasion because a grandchild had just been born and was coming home from the hospital. As the first daughter, she was named after the father's mother and had to pass through her grandmother's house before she went home. Evidently, for Kikuyu people, there are strict rules about what to name each child—the first daughter after the father's mother, the second after the mother's mother, then on to the parents' brothers and sisters. The family conversed in English, Swahili, and Kikuyu there were maybe twenty people there, and all the kids the same age had the same names, which added to the general confusion. Also there was the new baby's great-grandmother, a woman of nearly 100 with dangling stretched earlobes. Apparently, she is a bit senile, but if she could remember everything that's happened in the last 100 years, that would be amazing. I congratulated myself on working my way through a heaping plate of food at 3 in the afternoon, but just as I was taking my last bites a bowl full of roasted goat meat was placed before me and I had to incur the profound disappointment of the grandmother who asked me, wasn't the food alright?

And then I decamped to Kisumu, my home base for the next 8 or so weeks. I didn't know anything about the town except that it is on Lake Victoria. It's actually very lovely—the downtown is comprised of white two and three story buildings and is overrun with bicycle taxis. At the shore, there is a row of tin shacks serving huge fish that are deep-fried whole and served with tomato sauce, greens, and ugali (stiff corn porridge), one of the most delicious meals I have ever eaten. I found a place to live with a family in a Kenyan version of a gated community—paved streets in a neat grid, house numbers, and the "estate" has a school, a soccer field, and a small pub. The funny thing is that there isn't any visible extra security, just one gate that is unguarded and always ajar. Yet somehow the imposition of order keeps the usual African chaos at bay. Or maybe I'm missing something. My host mother, Florence, is a nurse from the TB ward at the provincial hospital and she invited me to live with her "African-style". She promised that I would only have to share a room with her 7 year old daughter, but the other day I looked over and the bed next to mine had 4 people in it. I suppose a better person than I would have offered to share, but, let's be real, I need my beauty sleep.

And then this last week I made a trip to the small town of Nyamira. I knew nothing about the place except that the district hospital was one of the sites that the people at the head office wanted me to look at. It is up in the hills and from the guesthouse there is a gorgeous view of the valley below, a green patchwork of small farms, mostly growing tea. The other afternoon, it rained and you could see it coming from the opposite hill, the shopkeepers packing up their wares as the first fat drops fell. The town itself consists of some general shops lining a single road, trafficked primarily by pedestrians, and there is no internet or restaurant anywhere. Still, at night, the bar across the street was blasting Congolese music and it sounded like plenty of people were there having a good time.

And there is the project I am doing. Basically, this province has a very high prevalence of HIV, and the prevalence is even higher among expectant mothers (20-30%). Most of these women attend some form of prenatal care, so that is a really important time to make sure they get tested for HIV to prevent transmission to the baby and to provide the mother with care. There are different ways that facilities are trying to follow up with HIV-positive pregnant women, so I am going to three of these to compare how their programs are working. The hospitals record all their data on paper (the one I was working at is the largest in the district and has a grand total of 2 computers for the whole facility) so I found myself entering data into my laptop in various wards while trying not to be distracted by the screams of babies being vaccinated, women giving birth, and one very disgruntled cow in the field beside the records office. The worst part about the project is seeing how under-resourced the health workers are, and then knowing that I have to bother them in order to make my project happen. Instead of feeling like I am doing something helpful, I can see that my project actually has a direct negative impact on patient care. To assuage my guilt, I attended a meeting of an AIDS patients club to offer moral support. As I should have expected, I was treated like the guest of honor, and ended up blathering about human rights in Swahili for a good chunk of time, as if those poor people hadn't suffered enough.

I have to say that traveling like this, with a task, can be a lot more interesting than pure tourism, even though I am only here for a relatively short time. In addition to that ridiculous speech, I got to play and sing with a group of HIV-positive toddlers at another hospital and to attend a soccer practice for a team of boys from Kisumu's largest slum. I have been invited for dinner at several houses and I just feel much more connected to the places I've been. It's not really about authenticity, because I know that I am still in Kenya's little public health world, but about actually being here, instead of feeling like I am just passing through. Kenya is great, and I'm having a really good time.

What the HIV clinic is like

2006-06-10T03:59:00.000-05:00

I spent several days this week at one of the better “Patient Support Centers” in Western Kenya. They are called that because other places have found that calling it an “HIV clinic” deters people from coming. Supported by the government and several NGOs, this particular clinic offers free medications including multivitamins, treatment for opportunistic infections, and as of June 6, antiretrovirals. The place has been recently refurbished and the waiting room is private. So this is one of the better places around for people with HIV to go for care.

But the atmosphere can be grim. People who are coming for follow-up visits often look unhapphy and anxious not to be seen, even if they are still healthy. Many of the people at the clinic are arriving for the first time—they have been admitted in the ward for some illness and the doctor recommended they be tested, or they had a persistent cough and have now been diagnosed with TB and HIV on the same day. Or, for the women I am trying to learn about, they came to the hospital for a routine prenatal visit and now their world has been shattered. All of these people have the shell-shocked and sheepish expressions of people that have just been thrown into a stigmatized group and handed what is still a death sentence at the same time. The people who come in sick are the worst, they are ashamed of their ill health, and some of them look like they expect to die. They register at the front desk and then they wait to see the doctor. Since the patients are many and the doctor is only one, they wait a long time.

But this clinic has a program of peer escorters--HIV infected volunteers at the clinic to show people where the lab is, to accompany people who have just been diagnosed, and to help with routine tasks like opening files. There is also a long-term Japanese volunteer who speaks Swahili (which, oddly, she and I used as our common language). These volunteers and the nurses maintain a banter that is noisy and cheerful, and make the clinic seem like more of an ordinary, lively place and not as much a house of death.

Then, too, there are patients like the baby I saw, her face covered with sores, her eye swollen shut and too lethargic to fuss, and no one could laugh when they saw her.

More mundane

2006-06-10T03:46:00.000-05:00

So I realize that in my dispatches I tend to forget to include the more mundane aspects. So, in addition to the fun and exciting adventures I've been having:

I fell down (yes, again) and scraped my knee and so now have a big scab that everyone seems to need to comment on.

I have to buy a new toothbrush because of an encounter with my old friend, the African cockroach.

When I got on the bus to Kisumu, they had some security officers with handheld metal detectors. Since I am carrying laptop, camera, taperecorder, cellphone, and various plug convertors, I set it off about 14 times. However, since I am also trying not to look like The Perfect Robbery Victim I declined to open my bag in the middle of the bus station, and so just whispered in the guard's ear what each beeping was and asked her to believe me that they weren't weapons. She did.

Prenatal Care in Kisumu town

2006-06-01T11:01:00.000-05:00

I spent a recent afternoon in the public hospital in Kisumu. The hospital is a complex of small buildings set in a grassy space, and it is the best cheap option in town. We started at the administration office, a perceptibly decaying building at the back of the complex. The head administrator’s office had a tiny waiting room presided over by a secretary with a manual typewriter. The maternal and child health clinic had a room smaller than my living room, jammed with mothers holding sick babies and children. In this room, the babies were weighed, vaccinated, and seen by the one doctor.

The worst was the maternity wards. There was one room for women in labor and women with complicated pregnancies, which was full of patients and their family members. There was a non-sterile theater for deliveries, and then another room for women who have delivered. The nurses told me that the bed shortages are so acute that they keep women for about 6 hours only after delivery, and that sometimes women who have had caesarean sections or who have just delivered have to share a bed. It makes you understand why 60% of women here deliver at home.

The best, most impressive thing about the hospital was the determination and caring of the staff. They all obviously knew and felt bad that they were not providing a high enough standard of care. All of them have insane workloads, and despite the fact that this hospital now has HIV treatment and medicines for preventing mother to child transmission, they are missing other essential supplies and their patients often can’t afford to buy the prescriptions or follow the advice that the doctors give them. At the public hospitals they work longer hours and are paid less than at private. So many of them burn out on patient care, and if they are well-connected, they find a position in the private sector, or an administrative role for an NGO or aid agency or in another country. They know that they are needed at the bedside but without support, the task is too hard and the sick patients are too many. Without enough resources, patients will never be well served.

A certain Kenya

2006-05-26T15:16:00.000-05:00

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.

Article in Context

2006-05-25T05:14:00.000-05:00

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.

Plea

2006-05-18T09:21:00.000-05:00

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.

Ongoing outrage in Somalia

2006-05-18T09:08:00.000-05:00

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.

Not just me

2006-05-14T19:56:00.000-05:00

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.

New threats to cheap meds

2006-05-11T16:27:00.000-05:00

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.

Fewer foreskins, less AIDS?

2006-05-02T16:47:00.000-05:00

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.

Another bad Bush policy with devastating consequences

2006-04-29T17:49:00.000-05:00

I'm working on a paper for class on the feasibility of elimination of landmine injuries worldwide. In case anyone was looking for another reason that the current administration is the worst ever, you can add to their faults their landmine policy. Basically, there is the 1997 Mine Ban Treaty, which 80% of all the countries of the world have ratified; in the Western Hemisphere, only us and Cuba haven't. This treaty has been successful in getting many countries to stop producing, trading, and using landmines, and it has mobilized funds for humanitarian demining in affected communities.

Clinton administration, of course, should have ratified at the outset, but they complied with some of the key provisions and planned to ratify by 2006. Bush and co changed that plan, and want to spend millions to research so-called "smart" mines. Their new policy is to increase money for humanitarian demining, phase out persistent mines, and stop using and exporting non-detectable mines. The State Department white paper on this policy claims that it is actually following a higher standard than the Treaty sets, because their self-deactivating mines are safer and the treaty does not allow anti-vehicle mines with anti-handling devices. (This last part is just a lie--the definition of anti-personnel mines in the treaty clearly applies to that type of anti-vehicle mine.)

Humanitarian demining of course is extremely important, and the US government is the largest funder of these projects in the world, but let's face it; that money goes directly to American private contractors and not to landmine victims. The problem with self-deactivating mines is that they malfunction at an unknown rate, and their components can be harvested and used to create improvised explosive devices like the ones which have been so deadly for US soldiers in Iraq (and which the treaty also bans). But the real problem is that the very fact that they are snubbbing this international treaty is detrimental. Even if the US can produce self-deactivating mines that never malfunction, can other countries? Will they claim that they do and then not do it? That's why the treaty calls for a ban, that's why there are no exceptions. The US government has the third largest stockpile of landmines in the world--after China and Russia, other non-parties to the convention--a fact that is surely not lost on the four governments and dozens of non-state actors that deployed landmines in 2005.

If the US is concerned that the treaty sets an insufficient standard, they should ratify it and then apply their own more stringent standards to their stockpile. That would be a consistent policy that sends a clear message that the US thinks that the 20,000 people who lose limbs, eyes, and hearing every year due to landmine explosions are an unacceptable tragedy.

A corrupt criminal receives a warm welcome

2006-04-19T09:42:00.000-05:00

A Washington Post editorial points out that Condoleeza Rice has nice words for the corrupt despot who rules Equatorial Guinea. Here is the Secretary welcoming an old-style African "big man" who shamelessly flaunts his personal wealth while 3/4 of the population suffers from malnutrition. Equatorial Guineans deserve to benefit from the oil wealth that flows beneath their country, but they never will with their current leader.

If the US is serious about fighting poverty, here is a textbook case where poor governance is wasting precious resources. At the very least, our government should publicly condemn this man instead of glad-handing him. But when corporate interests rule government, the poor everywhere always lose.

Being an Easter Person

2006-04-16T12:00:00.000-05:00

Easter Sunday, my church was beautiful. Sunlight streaming in the clear glass windows to illuminate the pale blue walls. The soaring white ceiling over a garden of people underneath--little boys in seersucker jackets and girls in dresses with matching hair ribbons, old men with comb marks in their hair and women in pastel suits and flowered dresses and multicolored scarves.

The sermon centered around the idea that "we are Easter people living in a Good Friday world", Good Friday, of course, being the darkest day of the church year, when Jesus has been crucified and all hope seems to have died. That is exactly how I feel when I think about the world today--when I feel the worst thing has already happened and the next day brings news of something worse. But the sermon offered the idea that "we have the right to hope", even if the misery in this world is overwhelming and injustice is spreading like a stain. Regardless of the worship you do or do not attend, to hope for the impossible, to hope for a better world, to me that is the deepest form of faith. And our collective hopes are the only chance for change.

Less AIDS in Africa?

2006-04-10T10:15:00.000-05:00

An article in the Washington Post from Thursday, April 6, talks about how estimates of HIV and AIDS burdens in African countries have been gradually revised down as better data becomes available. Now, to estimate prevalence, researchers conduct random testing, and verify positive tests. But, in the early days of the epidemic, researchers estimated prevalence using blood samples that they took from women attending prenatal clinics in urban areas, assuming that these women represented the general population. The tests they used to determine HIV status also returned a lot of false positives. So the numbers were higher than they should have been.

The article implies at points that UNAIDS may have issued extremely large estimates in order to mobilize funding. But accidental systematic overestimation makes sense—with limited data, the assumptions were flawed and the models were flawed, so even as more data was gathered, the estimates were still too high. Plus, the downward revisions may affect national prevalence estimates, but there are still extremely high rates in sub-populations, including people in most countries’ most productive age groups. And even if the UN had to revise its estimates for Africa, the revision was from 30 million to only 25 million.

25 million people are living with HIV in Africa.

My new favorite PAC

2006-04-05T08:28:00.000-05:00

Scene from the Southern Regional March for Peace and Justice, Saturday April 1. It was a great march--very joyful and noisy and all kinds of people from punks to grannies to veterans to babies in strollers. The route was a bit odd--just through some residential neighborhoods, but the traffic we stopped was mostly cheerful and the parked cars were laying on the horns. I got handed a sign that said "People over Profits" and late in the march somebody lent me a drum. My president may not care what I think about the war, but at least I got a chance to go out and say it.

To Ireland, with friends

2006-03-26T10:23:00.000-05:00

One of the best parts about being a "permanent student" is the frequency of vacations. My Spring Break happened to line up with that of H, a college friend who is also a permanent student. So one Friday we rendez-voused at a New York airport, got on a plane, and woke up in Ireland.

D, a friend of mine who volunteered with my organization in Tanzania, is Irish and graciously put us up in her apartment in Dublin. H and I explored the city for two days; Trinity College, city parks, the River Liffey, and the rows of storefronts--groceries and pubs and take-aways. We took day trips out of the city to small towns nearby. In Howth, we discovered an off-limits castle that is still partially inhabited and went on a breathtaking cliffside walk overlooking a broad bay. In Dalkey, we braved unremitting rain to find some old castles nestled in a small town, and climbed a big hill just to be in the general neighborhood where Bono lives. In Kilkenny, we roamed the town that still mostly reflects its 15th century layout. We saw the superstar attractions (cathedrals, castle), but a brief unguided wander revealed massive centuries-old churches at the head of each narrow street. My breath caught when I wandered in to the medieval stillness of the Black Abbey. Everywhere we went, we ate like queens, took pictures, marveled at the usefulness of our waterproof shoes, and just generally enjoyed each other's company.

Nevertheless, one day we split up, and while H tackled an impressive set of art museums and specialty stores, I headed to the countryside. In the small town of Navan, I got directions to a walking path that ran between a river and an old canal that was punctuated by vine-covered stone bridges and abandoned locks. After about 90 minutes of walking, I rounded a bend and glimpsed the towers of a ruined castle on a hill across the river. Grey clouds rolled behind it and a flock of ravens circled it, I kid you not. I walked further and saw that directly opposite the castle, on the other side of the canal, was a spooky red mansion with tall dark windows and an umkempt lawn descending to the river. A single light glowed on the downstairs floor. A little further along, I made my way across the canal on a few slippery branches and climbed up a hill to yet another ruin--an old church with a tiny graveyard, encircled by a low stone wall. I ate my lunch surveying my surroundings--river, green rolling hills, abandoned castle. Lovely (see below).

For St. Patrick's Day, we were in the Western town of Galway, where we watched a noon parade of school bands, acrobats, traditional Irish sports teams, bagpipes, huge puppets and immigrant community groups. There was live music and food stands all over the pedestrian area of their small town center, and some people were tipsy by 4 pm. The overall atmosphere was joyful and pleasant; we had a great time.

On our last night, we ate dinner in a seafood restaurant in a small coastal town, where by pure dumb look we were seated by and window and saw fireworks set off over the sea. That night, we went with D and her siblings to the pub in their small town, and toasted our trip.

Did you know?

2006-03-10T10:52:00.001-05:00

Right now, Tanzania is facing a severe food crisis and power shortages. The short rains failed last August, after I left. Electricity is rationed to about 6 hours per day in the capital, the prices of staple foods have doubled in the last month, up to 10 million of the country's 35 million people will need food aid in the coming months, and the amount of water behind the major dam only provides half the electricity that the nation needs. It's a crisis that no one can manage and that affects all the people in Tanzania, from the industrialists to the pastoralists to the Seventh Day Adventists

I guess the deepening misery of one of the world's poorest countries is not interesting to America's news networks.

Sick children

2006-03-10T10:37:00.000-05:00

The New York Times has a beautiful article this week about treatment programs for children with AIDS. A lot of times the 2.1 million HIV positive children are forgotten when talking about the pandemic (including in the school of public health) but their misery is just as great, and their capacity to respond to treatment and live is good, too.

Of course, as the article points out, pediatric formulations of HIV medication are not as well researched, not as available, and are much more expensive. One of the most promising new drugs is Kaletra, manufactured by Abbott Labs in Illinois. But there is currently no timetable for issuing a pediatric formulation. Abbott says that the liquid suspension is the pediatric option because it can be divided to adjust dosing, but the liquid requires refrigeration and is too bitter for children to take. If you think that Abbott should work to make this important drug available to the children who need it most, you can call the CEO and leave a message on his machine telling him so.

Miles D. White
CEO, Abbott Laboratories
Phone: 847-937-6100
Fax: 847-937-1511

For more information about what you can do, click here.

Back to the World

2006-03-10T10:24:00.000-05:00

So Emily's worldview has been, er, narrowed lately, restricted mostly to computer screens, lecture halls, committee meetings, readings, etc. I did manage to work ahead and fit in a rock concert (awesome show--The Strokes) and a few hours of socializing, but wow. Today is the first day of my great spring break, which I will be spending in Ireland with two dear friends. I went out shopping for rainproof things last night, and wandering around the travel store made me really miss being on the road and embarking on daily adventures.

Fortunately, one of the things I have been working so frantically on is a proposal for my summer research, which has been accepted on all sides. I will be spending 10 weeks this summer in Western Kenya, working with an international aid agency that provides antiretroviral therapy to people living with AIDS! Specifically, I will be looking at ways to better connect pregnant women who come in for routine antenatal care with HIV testing and treatment if they need it. The project is perfect, it's my life's passion and a perfect next step for me.

And from there I will go to Australia for a whirlwind vacation with my family. So by August, I will have been on four continents and literally have traveled around the world. And I am so lucky for it.

A new language

2006-02-16T21:35:00.000-05:00

This semester I am taking classes in Strategies, Proposal Development, Monitoring and Evaluation. I am learning about conceptual frameworks, results frameworks, evaluation frameworks, log frameworks, and the difference between aims, objectives, goals, and expected outcomes. It's all DevSpeak, it's paper. But at the moment it seems worthwhile to learn. I can't tell if that's just become I'm in this public health industry bubble, if I'm learning the system so I can someday change it, or if it maybe actually does.

Working for it

2006-02-01T23:38:00.000-05:00

So I haven't posted at all about my job. The work I am doing is really not public-health related, it's not a good way to meet people, it's a lot of hours without a lot of exposure, and it's not even currently on my resume. And it's hard. But I love it. I'm the research assistant to a Sociology professor who has a serious degenerative condition. He can't speak and can barely move at all; he breathes with a respirator. To communicate, he has to painstakingly type on to a laptop, using special software that allows him to navigate a computer using just his foot.

His mind is not affected at all.

He's fifty years old, recently divorced with teenage kids and he should be in the prime of his career. Instead he breathes with a machine, relies on his mother to pay his bills, and requires 24 hour nursing care just to stay alive. He is in pain often, there are many things he can't do, and we constantly have to stop working so that he can communicate with his nurse to reposition his body, or give him some medicines. But he doesn't just mope around--no, he is still researching and collaborating with colleagues and I make it possible for him do that.

Recently, someone from the Sociology admin office yelled at me. Basically, she said I was helping him too much with his personal affairs and that the department wasn't paying me to do that. If I was doing the work just to get paid, I might have listened. But as it is, I will continue working for him as hard and as well as I can, because that is what matters to me.

Waiting for health care

2006-01-23T21:29:00.000-05:00

In the New York Times today, there is an article about the overburdened emergency rooms, in New Orleans. It describes patients waiting for six hours to be seen, inadequate equipment, overburdened staff, and people being forced to travel to health facilities far away for non-life threatening emergencies like broken limbs.

It struck a chord with me because just this week I have been working on an essay about what it was like for my neighbor in Tanzania when he needed surgery. In short, it was exactly like that, and he was in an area of the country with relatively better health facilities than elsewhere, including one of the best hospitals in the country. Sometimes, here, we take health care for granted and marvel when it is not there for us. But for most people in most places it's never there to begin with.

Tax dollars at work

2006-01-23T21:24:00.000-05:00

This is an amazing graph showing how the Congress spends its discretionary funds. More than half of those go to the military. Click to enlarge, scroll around. Check out the tiny circles representing famine relief and assistance to poor families, the big ones for space programs. Here are Congress' priorities.

Guilt

2006-01-11T22:08:00.000-05:00

I don't even remember what it was, but I recently was accused of doing something solely to assuage my liberal guilt. Which got me thinking, is feeling guilty really a bad thing? I guess the whole idea of liberal guilt is that some people know that there are all kinds of injustices and outrages in the world, and they feel so powerless to change the whole constellation of iniquity that they may take a few piecemeal actions but won't do anything to alter their whole lifestyle. And they feel guilty about it, and that's a pointless thing to feel.

But what is the alternative? Not feeling guilty? I guess some people think they deserve to buy cheaply made goods from sweatshops, and burn limitless oil that pollutes the air, and benefit from trade barriers that protect the local way of life while keeping poor people around the world on their knees. But do those people take substantive action more than guilty-feeling people do?

Obviously, feeling guilty and doing nothing is a worthless exercise. It's self-indulgent. But if feeling guilty means you recycle, and give to charity, and take the subway to work, and read about Darfur when it shows up on the Op-Ed page, and maybe write a letter to Congress, isn't that something? Even if a personal decision to walk to the mailbox instead of driving doesn't change the level of greenhouse gases in the atmosphere a single iota, it is still ethically a good decision. We are all guilty, and we have to act like we know it.

It's not enough, but it's something.

War on what?

2006-01-10T22:38:00.000-05:00

So I know I'm weeks behind the rest of the world on this one, but I recently saw Bill O'Reilly on Letterman, and was really struck by how contradictory the idea of the War on Christmas is with conservatism. I mean, basically, O'Reilly and crew have a handful of examples of local governments and institutions that have decided to make their holiday observations more tolerant--not allowing a public nativity scene in Texas, changing the words to Silent Night in Kansas. But local communities have the freedom to observe holidays how they want, and it's conservatives who traditionally support their autonomy.

Moreover, if conservatives want to find a conspiracy that is undermining our (supposedly universal, supposedly stable) "culture of Christmas", they could look to the major corporations which have changed the season, the decorations, the meaning of Christmas from a religious holiday to a consumerist one. But major retailers are not targets for conservative ire; local school boards are. Sigh.

Everything Relaxed

2005-12-29T12:07:00.000-05:00

I've been on vacation for almost two weeks, and just let everything go. I've been following the example of our black and white cat--sleeping in, eating when I feel like it, lazing around the house, letting my whole body go as limp as a noodle. I've relaxed in some other ways too--driving everywhere, buying things at regular stores, only reading the Washington Post. Who knew it would be so easy to take a vacation from my principles?

I spent a lot of time with one of my friends from way back, which reminded me that the good thing about having friends from forever ago is that you don't have to be 'on' to be with them, you don't have to be anything but yourself. And with my family even more so--I can unselfconsciously be the same dorky kid I've always been. It's great to meet new people and to be surrounded by unfamiliar faces, but it's also pretty great to be home and to remember what I'm like when I'm totally comfortable.

Boo to Paul Theroux

2005-12-17T22:56:00.000-05:00

In this week's NYTimes, Paul Theroux reveals that he finds Bono "annoying" because the rock star is always pushing the "big money platform", that increased aid, fairer trade relations and debt relief are crucial to real development in Africa. Theroux thinks this results in perverse outcomes, and that self-sufficiency must come from African governments and African people cleaning up their acts.

By the way, this man's credentials are that he wrote a prize-winning novel and did a few years in Peace Corps in the 70s. He's basically the literary-rock-star version of Bono, except without a real plan. I mean, what is his alternative? Encouraging young local professionals to stay and work. Great, except for, um, AIDS, which kills exactly those people at faster rates than those countries graduate them. When you have HIV epidemics of 10-40% in the general population, you can't rely on the piecemeal stuff that he supports; "humanitarian aid, disaster relief, AIDS education or affordable drugs". You have to make it possible for governments to have enough money to do those AIDS treatment programs, forever. And the infrastructure issues he talks about at the end are exactly the types of projects that foreign aid is pretty good at doing and should be doing more of.

Of course, he's right that money has been wasted in the past, often by the governments it was going through. Remind me again why the poorest people in the world are being asked to pay for bad deals between their corrupt rulers and misguided international lending institutions? And what about all the well-designed, transparent, high-level HIV, malaria, and TB projects that the Global Fund has approved and that are just stagnating while they wait for funding?

Here's the thing; even if debt relief and aid do not always lead to improved welfare, there is just no scenario where a heavily impoverished and indebted nation can turn itself around within the current world system. Development is not the necessary result of more aid; but aid and trade and debt relief are all sine qua non for development.

Obviously, there's a lot that's indefensible that goes on in the aid world, and I agree a lot with the critiques like the one I discussed in my previous post. But those critiques are made analytically and descriptively and they aren't used to undermine the fundamental principle that rich people have an obligation to use their wealth in service to the poor. A principle that Bono has a big role in bringing to the international table. Now that's a real rock star.

Aid Industry

2005-12-08T17:27:00.000-05:00

I'm in the middle of finals so not much time to post. I wanted to point out a great article on Malawi in the Times this week. It nicely summarizes the contradictions in the "aid industry" in Africa. I think it's actually a little gentle--for example, CARE in Malawi gets to explain away its part in exacerbating poverty in Malawi by its limited geographic scope. As a matter of fact, CARE is currently working in 60 countries around the world. Perhaps they would be more effective if they were less concerned about lifting their own profile and sucking up as much donor money as possible, and more concerned about actually dealing with entrenched poverty in the countries they are in.

Many of the international NGOs are the same, of course. Which is a problem for someone who feels like she is being groomed to join just that kind of organization; who wants a job in Africa, but not at the expense of the destitute poor who live there.

Wow

2005-12-04T17:51:00.000-05:00

Buenos Aires' World AIDS Day celebration. As my friend Amanda said, "I just can't picture them doing that to the Washington Monument". I'll save the comparison of Brazil's enlightened AIDS policy with America's non-policy for another day, and just let the picture speak for itself.