Thursday, 9 December 2010

US State Department announces World Press Freedom Day: A superlative for hypocrisy is needed

Having spent the past two weeks doing everything it can to shut down some creepy man's website and his access to his funds, the US State Department in its wisdom found  today to be the day to announce that the US will host the World Press Freedom Day next year, which will focus on freedom of information on the internet . In the announcement they voiced their concern "about the determination of some governments to censor and silence individuals, and to restrict the free flow of information.”

From the official announcement: 
The theme for next year’s commemoration will be 21st Century Media: New Frontiers, New Barriers. The United States places technology and innovation at the forefront of its diplomatic and development efforts. New media has empowered citizens around the world to report on their circumstances, express opinions on world events, and exchange information in environments sometimes hostile to such exercises of individuals’ right to freedom of expression. At the same time, we are concerned about the determination of some governments to censor and silence individuals, and to restrict the free flow of information. We mark events such as World Press Freedom Day in the context of our enduring commitment to support and expand press freedom and the free flow of information in this digital age.

In January, Hillary Clinton gave a powerful speech on the internet, calling it the 'iconic infrastructure of our age' and warning that "As in the dictatorships of the past, governments are targeting independent thinkers who use these tools." She meant China and other undesirables of course, not herself and her department.

Calling it hypocritical doesn't quite cut the mustard - it's time to coin a superlative.

To a add a significant caveat:  placing so many private individuals unredacted names on the web, as the US embassy cables do, displays deplorable recklessness . These people have families and careers one presumes that they wish to protect and nurture. This is not the first time that Wikileaks has recklessly placed people at risk, e.g. Amnesty International's unheeded warning that publishing the names of Afghan's working for US and other foreign forces puts them in immediate danger of assassination.

Monday, 6 December 2010

to state the obvious: Wars cause Disease

UNICEF are calling for a cease-fire in order to administer polio vaccinations in war-torn regions of the DR Congo as the disease makes an aggressive return in the area. Polio vaccination teams have struggled for many years to get to war-torn areas, leaving large segments of the population unvaccinated against the highly contagious disease. 

But the break-down of basic health services is by far not the main cause of war-time disease. Armed conflicts have long been associated with disease outbreaks by creating the necessary conditions for epidemics to explode: destruction of infrastructure including water supply and sanitation facilities, displacing civilians and creating refugees who are often driven into overcrowded and unsanitary settlements.

Dormant diseases can surge back to life in the event of war, as in the case of typhus which after an absence of twelve years broke out in the refugee camps created during the Burundi civil war in 1993. 

Malaria has also shown to spike when populations are displaced, as refugees travel they are exposed to strains to which they have little resistance and then transmit the disease to populations that they come in contact with as they continue their trek.  Regnol-Querol found that 1000 civil war refugees raise the incidence of malaria in the recipient country by 1400 cases.  The upheaval and massive population movements during the Russian Civil War caused a major malaria epidemic in Volga basin, which stretched northward as far as the Arctic Circle - hard to imagine in a disease which we now view as tropical.

Soldiers are of course no less susceptible to war-time epidemics than the civilian  population. For example, it  is estimated that during the American Civil War malaria killed three out of five Federal casualties and two out of three Confederates. In the Russian-Finnish conflict in the 40's malaria was also a major cause of death among the troops.

Conditions of war not only exacerbate endemic disease but can also cause new disease to appear. Armed conflicts in the Great Lakes region in Africa have displaced millions in the last few decades, many of whom have been driven into normally uninhabited jungle where they come into contact with the natural animal hosts of hitherto unknown diseases; disease which they may contract and pass onto the general population. This is likely the cause of the Ebola, first identified in the DR Congo  In West Africa the increase in outbreaks of  new haemorrhagic fevers are likely to have first been introduced to humans from monkeys when refugees in Liberia and Sierra Leone were displaced into the surrounding jungles

The 1918 Flu pandemic, which killed at least 40 million people was a new and terrifying strain believed to have emerged from over-crowded training camps and barracks in the UK, where there were reports of young men dying soon after first displaying symptoms of a pneumonic, flu-like illness. When the men were sent off to the front, they came in contact with hundreds of thousands of other soldiers, allowing the virus to spread, change and mutate and become even more virulent. The frontlines had all the conditions of refugee camps, with hundreds of thousands of young men living in squalid unsanitary, overcrowded camps, ideal areas for the spread of disease. When the soldiers left the frontlines and returned home, they came back carrying more lethal forms of the virus which they re-introduced into the civilian population.

How to write about Africa

I just came across this fantastic satrical piece on cliches of Africa written by Binyavanga Wainain and published in Granta Magazine:

Always use the word ‘Africa’ or ‘Darkness’ or ‘Safari’ in your title. Subtitles may include the words ‘Zanzibar’, ‘Masai’, ‘Zulu’, ‘Zambezi’, ‘Congo’, ‘Nile’, ‘Big’, ‘Sky’, ‘Shadow’, ‘Drum’, ‘Sun’ or ‘Bygone’. Also useful are words such as ‘Guerrillas’, ‘Timeless’, ‘Primordial’ and ‘Tribal’. Note that ‘People’ means Africans who are not black, while ‘The People’ means black Africans.

Never have a picture of a well-adjusted African on the cover of your book, or in it, unless that African has won the Nobel Prize. An AK-47, prominent ribs, naked breasts: use these. If you must include an African, make sure you get one in Masai or Zulu or Dogon dress.

In your text, treat Africa as if it were one country. It is hot and dusty with rolling grasslands and huge herds of animals and tall, thin people who are starving. Or it is hot and steamy with very short people who eat primates. Don’t get bogged down with precise descriptions. Africa is big: fifty-four countries, 900 million people who are too busy starving and dying and warring and emigrating to read your book. The continent is full of deserts, jungles, highlands, savannahs and many other things, but your reader doesn’t care about all that, so keep your descriptions romantic and evocative and unparticular.

Make sure you show how Africans have music and rhythm deep in their souls, and eat things no other humans eat. Do not mention rice and beef and wheat; monkey-brain is an African's cuisine of choice, along with goat, snake, worms and grubs and all manner of game meat. Make sure you show that you are able to eat such food without flinching, and describe how you learn to enjoy it—because you care.

Taboo subjects: ordinary domestic scenes, love between Africans (unless a death is involved), references to African writers or intellectuals, mention of school-going children who are not suffering from yaws or Ebola fever or female genital mutilation.

Throughout the book, adopt a sotto voice, in conspiracy with the reader, and a sad I-expected-so-much tone. Establish early on that your liberalism is impeccable, and mention near the beginning how much you love Africa, how you fell in love with the place and can’t live without her. Africa is the only continent you can love—take advantage of this. If you are a man, thrust yourself into her warm virgin forests. If you are a woman, treat Africa as a man who wears a bush jacket and disappears off into the sunset. Africa is to be pitied, worshipped or dominated. Whichever angle you take, be sure to leave the strong impression that without your intervention and your important book, Africa is doomed.

Read the rest at Granta Magazine. 

Tuesday, 23 November 2010

An HIV/AIDS Reading List

In the formidable The Invisible Cure, Helen Epstein chronicles our failure to do the right things to curb the HIV/AIDS epidemic in Eastern and Southern Africa - impeded as we are by too much ideology and too much political correctness.  It's not spoiling the ending to tell you that the cure in the title refers to cutting down on concurrent sexual partnerships.

In the equally formidable The Wisdom of Whores, Elizabeth Pisani.Pisani chronicles our failure to do the right things to curb the epidemic in S.E. Asia - impeded as we are by too much ideology and too much money. Here is Pisani talking at TED:

Having just read these two back to back, their similarities are stark. The message in both is - follow the data, not the ideology.  But they do discuss two very different epidemics - in S.E. Asia HIV is concentrated in high risk groups with little danger that the epidemic will explode in the general population. Politcal squeamishness and voter disapproval of directly addressing injection drug use and risky sex has led to health messages which largely miss the point.

Conversely, in Southern Africa, Epstein laments the focus that has been placed on high risk groups despite the vast majority of new infections being  transmitted through heterosexual sex within long-term relationships, meaning not only that the health messages miss their target, but they also add to shame and stigma, which further aids transmission.  One irritating thing about the Invisible Cure is Epstein's frequent talk of 'Africa', I'm sure she knows it's a big continent and that lots of it has about as much HIV as Switzerland. To quote Hans Rosling; 'we have to stop talking about Africa as if it's one place, it's not very respectful and it's not very clever'.

Read both if you can. If you can't, then read The Invisible Cure.

Saturday is for funerals by Unity Dow and Max Essex is a very different book.  Dow writes true stories of lives ravaged by AIDS in Botswana, with each short story followed by scientific commentary by Essex.  Half-way through I became indignant of how anyone could write about HIV/AIDS while barely mentioning sex, but this is a book about the disease of AIDS and it's impact on the lives of Botswanans, not about the spread of HIV. An exploration of how and why such a prevalent disease (one which in the years before widespread anti-retrovirals took up every Saturday for funerals) can be such an impenetrable taboo is unfortunately lacking. But it is a moving, compassionate and insightful book. I recommend it to people looking to learn a bit, but not too much, about AIDS.

Postnote: The Wisdom of Whores is available free of charge as an e-book for the month of December 

Sunday, 17 October 2010

Thailand's phenomenal success using the Salt'n'Pepa approach

Really impressive and funny enough to momentarily distract Mr. apublichealthblog from playing football on the playstation:

Mechai Viravaidya: How Mr. Condom made Thailand a better place

And yes, I have just worked out how to embed videos

Saturday, 16 October 2010

rswhat? RSS

It's come to my attention that many of my readers could benefit from knowing what rss is. It's a way of getting updates to blogs and other sites that you regularly visit without having to actually visit them to check if there's anything new. Here's a video, in German because all the English ones I came across were quite annoying. To read about it in English go here.

As I have a yahoo email account, I use My Yahoo to see the rss updates, but google reader (not email account related) seems to be the most popular. Set up an rss feed, I dare you. It's not revolutionary, but if you regularly check more than one site (which surely everyone with internet access does) it will make your life a little easier. And remember to add this blog to your feed by clicking the little orange button on the top right:)