Thursday, December 14, 2006

male circumcision and HIV

The NYT published an article today about how male circumcision reduces the risk of female-to-male HIV transmission by 40-60%.

This is pretty interesting. What's even more interesting is that I discovered a couple months ago that the social marketing NGO I'm partnering with (Society for Family Health, part of Population Services International) had been piloting male circumcision in Lusaka for several months already.

Sunday, December 10, 2006

zambia in the NYT

so there's a multimedia feature in the NYT about "Africa's children."

couple reactions--

-- the hospital they show in Lesotho is much more well-equipped than the health clinic I'm working at. At least that place has ARV drugs and a full-time doctor. My health clinic is always out of drugs and doctors visit 2 times a week or so while people die from HIV/AIDS, cholera, etc. in the wards.

-- that child, Alone, from Lusaka, Zambia is relatively lucky in that he at least has a job. Many children don't and they starve. And at least he goes to school. And at least Alone isn't a street child. Street children make money by having sex with older men and begging. They have no schooling.

Well, I don't mean to be a downer or anything.

I just don't like the way the NYT and other Western media only portray specific poverty in Africa while not making as much of an effort to explain context, history, and possible causes of poverty.

Friday, October 27, 2006

why NGOs are hurting sub-saharan africa

PUBLISHED AUGUST 25, 2006

Why has Africa been left out of the business revolution?

William Duggan, who worked for two decades on the problem of poverty in Africa, discusses an alternative to aid for the world's poorest countries.

Africa today has the most extreme poverty in the world. How has the West responded to this human suffering? Thanks in part to celebrities like Bono and Angelina Jolie, calls for increasing aid to Africa are becoming popular, even sexy. Bill and Melinda Gates are using their fortune to fight disease in Africa, particularly AIDS. And Warren Buffett, a graduate of the School, recently announced that he would give more than $30 billion to the Gates Foundation.

There's also a coordinated campaign to end poverty in Africa and other regions, a project called the United Nations Millennium Development Goals. These eight goals, which the UN hopes to achieve by 2015, include reducing extreme poverty by half, halting the spread of AIDS and ensuring universal primary education. Any role business might play appears only once on this list, in the very last item: a global partnership for development. By this, the UN means encouraging business to help with aid work, not business as an event in itself. The agents that are working towards these goals are governments and NGOs, not companies.

It's a noble effort, but does it work? Last year, the UN came out with its first five-year report on the Millennium project, and the picture was not very good. The UN has made little progress on any of these initiatives — because it didn't receive enough money, the report said.

After 40 years of aid that has climbed into the trillions, I think it's time to say that the lack of money isn't the real problem. The system just doesn't work. Sub-Saharan Africa is poorer now than it was in 1960. But the UN report did include one encouraging note about the elimination of poverty. In the last five years, two countries that are not part of the Millennium project showed tremendous improvement: China and India. The reason, the report said, was the development of business institutions and the private sector in these countries.

I am an economic historian by training, and I cannot think of a single country in which the private sector has not been the key to prosperity. Malaria and AIDS have become diseases of poverty. Florida once had malaria, but got rid of it through prosperity. Today, rich countries have protection from AIDS; poor countries get AIDS.

When trying to figure out how to help Africa, it helps to remember the tremendous success of the Marshall Plan. It pumped $13 billion — the equivalent of $80 billion in today's dollars — into European economies after World War II. The money was used not for charity, but to support the private sector. The plan gave loans to businesses, and when these loans were repaid, the proceeds were used to rebuild the commercial infrastructure. Likewise, South Korea, Japan and Taiwan all benefited from massive private-sector aid programs after World War II.

Back in the 1960, development agencies tried to figure out how much capital poor African countries would need to finally take off. They came up with an enormous number and calculated further that the private sector was too small or too weak to absorb that capital. So they launched government-sector development programs, and these not only failed but squeezed out the private sector where it was needed the most. The agencies had good intentions, but their strategy was fundamentally flawed.

The World Bank and the International Monetary Fund track business indicators around the world, such as how easy it is to start a business. In Canada, it takes two days. In New Zealand, it takes just two and a half hours. In Mozambique, it takes 153 days. Indicator by indicator, it's very clear that Mozambique is not interested in the business sector. Like most other African countries, Mozambique is very happy to get governmental and nongovernmental aid.

Many advocates for aid to Africa seem to be unaware of how important the private sector is for growth. The movie studios that made Jolie a millionaire are private companies, not NGOs. So are the record studios that gave Bono his fortune. Gates and Buffett are masters of the private sector. They have forgotten how they themselves became rich.

This isn't to say that charity has no role in African development. But right now, only a tiny fraction of aid goes toward private sector development. One very simple solution would be to increase that to 50 percent. If half of the aid that currently goes to Africa were spent on the development of the private sector and business institutions, Africa would be in much better shape. Frankly, time is running out.


Willam Duggan is associate professor of management at Columbia Business School.

Thursday, October 19, 2006

one more story

I was walking around the health clinic today when one of the CHWs (community health workers) I employ came up to me with a baby in her arms and a demanding look on her face. She held out her baby and said something about me buying the baby a napkin of some sort. Now, I've been approached a countless number by Zambians who have demanded (not asked... demanded) that I do certain things for them -- buy them food, buy them water, buy them umbrellas, buy them hats, buy them soda, marry them, etc. I've become accustomed to politely ignoring unreasonable demands. So I ignored the woman.

But she was very persistent. She kept on shoving the baby into my face and saying something about needing to buy the baby something. I walked away for a bit, but later, another CHW came back with the same baby.

"What is going on?" I think.

They start telling me about the baby, but in slower accented English, and I finally begin to understand. The original CHW had been missing for a while during our project, and I remembered just then that it was because she had delivered a baby... and the baby they were showing me was that baby. I nodded my head in understanding.

Then they told me that the name of the baby was Christina, in "honor of me" running the project while she was having the baby.

I didn't know what to say or think. She must be kidding. Was she lying? There's no way she would name her own child after me. She doesn't even know me that well. I'm not even that nice or kind or generous. To them, I'm the strict Chinese-looking American who refuses to give them salary raises.

I asked the women if they were lying.

"Yeah right, you can't be serious!" I said.

"It's true." the women said.

"Show me the birth certificate to prove it," I said

"There are no birth certificates," they said. "The child will receive an under 5 card, but not yet this baby is still too young."

At that point, I had to go do something else. But I don't know what to say or think  Was she serious? Is her name really Christina? And if it is, did she really name it after me? More likely, she thought my name was pretty and decided to use it. But still.... to name a baby after me? ......................... why would she do that? I would be unbelievably honored if she really did name it after me... but is it for any good reason?

don't really know what to write anymore

It's been tough motivating myself to blog because I know that I do not have the time or patience to fully describe all my day-to-day thoughts and experiences. Well, given that disclaimer, here's a few pitiful paragraphs.

This past Sunday's events were quite comical now that I think about it. I woke up Sunday morning with a weird feeling in my stomach. I laid down for a while but didn't think anything of it because I figured I was just getting sick from all the bug spray I was spraying around in the room. (killing moths, roaches, spiders, flies, mosquitoes, you name it.) I made myself get up and go to a church called Fairview Baptist with two expat friends. (By the way, I think I'm going to settle down at Fairview Baptist...wow, look at me, I'm a Baptist!) So I go to the church service, but the entire time I'm feeling slightly nauseous and saliva is collecting in my mouth. I leave the service a couple of times to go outside and spit out all the excess saliva. (One time, in the middle of one of the Bemba worship songs.. Bemba being one of the local African languages here...)  After the service meet and greet,  the expat girls and I meet up with Betty, a small, elderly Southern Baptist missionary lady from Texas with a pleasant Southern twang. (The funny thing is, she's lived in Africa for TWENTY years..... 15 of those years in the African bush.......... this is why she's so awesome.)

We pile into her pick-up truck. (Yes, a pick up truck.) It was a hilarious moment. There we were -- me, a Chinese-looking female, a young white female, and a young black female-- in the backseat and passenger seats, with a small, elderly Southern woman droving stick in the front.

We cruised our way to a cafe in Manda Hill, one of the two strip malls that represents the most upscale areas of all of Zambia. [You don't know how comforting it is to walk around a strip mall when you're in Africa... well for me at least....] We ordered. I ate oatmeal. We talked about Betty's experiences living in the bush. We talked about Zambian culture. And we complained about all the annoying things we had to deal with day to day while living here. It was quite cathartic.

Then we paid our bill, got up, and walked outside. On the way to the car, I started feeling really really bad. I limped over to a trash can. I spit out more of the collected saliva. Then I started gagging. Betty and the two other girls, who had gone ahead, came back and crowded around my hunched figure, concerned. Then... I threw up some oatmeal. They clucked in concern and handed me some tissues. I threw up some more oatmeal. They handed me some water. Several Zambians walked by me curiously. Normally, I would have been mortified if I was vomiting in public. But, I didn't really care-- I felt awful and it's not like I didn't stick out already. When I was finished, I rinsed my mouth, wiped my face, and said "Wow, I feel a lot better." Then we walked back to the pickup truck.

We went to Betty's house to hang out for the rest of the afternoon before the "International Bible Study." That's the expat / missionary Bible Study on Sundays that I've been regularly attending. (It's where I've befriended the Southern Baptist missionary couples.) It's run by the Southern Baptists, but open to any and all. At Betty's house, we lounged around. I looked at Betty's wall of books, and picked up John Eldredge's "Wild At Heart." I'd heard about the book, and had heard many Christian friends rant about and/or make fun of John Eldredge in general. I skimmed through it, and read about the deepest desires of all men's hearts-- something about adventure, battle, and beauty. The part about men longing for adventure struck a chord with me. I felt like that section described some of the deepest desires of my heart. I put down the book and went through one of my "I-should-have-been-a-guy" moments.

We went off to the Bible study. Despite feeling not-so-well, it was still a good session. A white South African man gave his testimony about accepting Jesus 7 weeks ago. Then 3 newcomers introduced themselves; they were part of the "Flying Mission"... I was unclear about what they did exactly...but from what I gathered, it was missionary work, but cooler, because it involved flying a plane. We went through Exodus, the part when Jethro starts giving Moses advice about how to organize the Israelites.

I started feeling aches and chills. I told my friends about it. "Maybe it's malaria," they said matter-of-factly. "Yeah, maybe," I replied. Visions of lying on a hospital bed for weeks close to death started forming. Then I remembered that I read somewhere that the malaria parasite only needs one night to multiply 2 or 3 fold. I began to panic a bit. I asked one of the Southern Baptist missionary couples who I'd befriended (not Betty, but another awesome lady) to take me to the 24/7 expensive expat medical clinic to get a blood test to see if I had malaria. By that point, I was 90% convinced that I had malaria.

When I described my symptoms to the doctor (a spectacled light skinned Zambian man with dreadlocks, a T shirt with Jamaican flags, and a lazy eye) and demanded that I get a malaria test, he started chuckling.

"You definitely do not have malaria," he said. He pointed out that I myself had said I had not gotten any mosquito bites for the past two weeks. He also pointed out that my temperature was normal.

"But, I have aches, chills, vomiting, and I feel weak," I protested. "That's most of the malaria symptoms right there!"

He grinned. "If you really had malaria, you wouldn't be able to argue with me," he said. "All first-time malaria patients have extremely severe symptoms."

"If it isn't malaria, then what could it be?!" I grumbled.

"Probably a virus of some sort. They're going around. Here, I'll prescribe you some anti-nausea medication."

"But.... how about some malaria treatment just in case?"

"Don't be like other Zambians," he said. "Every time they get sick, they think it's malaria. Most of the time it's something else."

Eventually, I conceded. I said I would visit the next day for a blood test if I still didn't feel better.

I went to bed that night worrying about malaria.

But I woke up the next morning, feeling almost completely better. So, it was indeed a temporary stomach virus. Whew.

Thursday, October 12, 2006

a confirmation of what we already knew.

so you, dear reader, do influence me. and I do influence you. what a comfort.

____________________________
The New York Times


October 10, 2006
Essay

Friends for Life: An Emerging Biology of Emotional Healing

A dear friend has been battling cancer for a decade or more. Through a grinding mix of chemotherapy, radiation and all the other necessary indignities of oncology, he has lived on, despite dire prognoses to the contrary.

My friend was the sort of college professor students remember fondly: not just inspiring in class but taking a genuine interest in them — in their studies, their progress through life, their fears and hopes. A wide circle of former students count themselves among his lifelong friends; he and his wife have always welcomed a steady stream of visitors to their home.

Though no one could ever prove it, I suspect that one of many ingredients in his longevity has been this flow of people who love him.

Research on the link between relationships and physical health has established that people with rich personal networks — who are married, have close family and friends, are active in social and religious groups — recover more quickly from disease and live longer. But now the emerging field of social neuroscience, the study of how people's brains entrain as they interact, adds a missing piece to that data.

The most significant finding was the discovery of "mirror neurons," a widely dispersed class of brain cells that operate like neural WiFi. Mirror neurons track the emotional flow, movement and even intentions of the person we are with, and replicate this sensed state in our own brain by stirring in our brain the same areas active in the other person.

Mirror neurons offer a neural mechanism that explains emotional contagion, the tendency of one person to catch the feelings of another, particularly if strongly expressed. This brain-to-brain link may also account for feelings of rapport, which research finds depend in part on extremely rapid synchronization of people's posture, vocal pacing and movements as they interact. In short, these brain cells seem to allow the interpersonal orchestration of shifts in physiology.

Such coordination of emotions, cardiovascular reactions or brain states between two people has been studied in mothers with their infants, marital partners arguing and even among people in meetings. Reviewing decades of such data, Lisa M. Diamond and Lisa G. Aspinwall, psychologists at the University of Utah, offer the infelicitous term "a mutually regulating psychobiological unit" to describe the merging of two discrete physiologies into a connected circuit. To the degree that this occurs, Dr. Diamond and Dr. Aspinwall argue, emotional closeness allows the biology of one person to influence that of the other.

John T. Cacioppo, director of the Center for Cognitive and Social Neuroscience at the University of Chicago, makes a parallel proposal: the emotional status of our main relationships has a significant impact on our overall pattern of cardiovascular and neuroendocrine activity. This radically expands the scope of biology and neuroscience from focusing on a single body or brain to looking at the interplay between two at a time. In short, my hostility bumps up your blood pressure , your nurturing love lowers mine. Potentially, we are each other's biological enemies or allies.

Even remotely suggesting health benefits from these interconnections will, no doubt, raise hackles in medical circles. No one can claim solid data showing a medically significant effect from the intermingling of physiologies.

At the same time, there is now no doubt that this same connectivity can offer a biologically grounded emotional solace. Physical suffering aside, a healing presence can relieve emotional suffering. A case in point is a functional magnetic resonance imaging study of women awaiting an electric shock. When the women endured their apprehension alone, activity in neural regions that incite stress hormones and anxiety was heightened. As James A. Coan reported last year in an article in Psychophysiology, when a stranger held the subject's hand as she waited, she found little relief. When her husband held her hand, she not only felt calm, but her brain circuitry quieted, revealing the biology of emotional rescue.

But as all too many people with severe chronic diseases know, loved ones can disappear, leaving them to bear their difficulties in lonely isolation. Social rejection activates the very zones of the brain that generate, among other things, the sting of physical pain. Matthew D. Lieberman and Naomi Eisenberg of U.C.L.A. (writing in a chapter in "Social Neuroscience: People Thinking About People," M.I.T. Press, 2005) have proposed that the brain's pain centers may have taken on a hypersensitivity to social banishment because exclusion was a death sentence in human prehistory. They note that in many languages the words that describe a "broken heart" from rejection borrow the lexicon of physical hurt.

So when the people who care about a patient fail to show up, it may be a double blow: the pain of rejection and the deprivation of the benefits of loving contact. Sheldon Cohen, a psychologist at Carnegie-Mellon University who studies the effects of personal connections on health, emphasizes that a hospital patient's family and friends help just by visiting, whether or not they quite know what to say.

My friend has reached that point where doctors see nothing else to try. On my last visit, he and his wife told me that he was starting hospice care.

One challenge, he told me, will be channeling the river of people who want to visit into the narrow range of hours in a week when he still has the energy to engage them.

As he said this, I felt myself tearing up, and responded: "You know, at least it's better to have this problem. So many people go through this all alone."

He was silent for a moment, thoughtful. Then he answered softly, "You're right."

Daniel Goleman is the author of "Social Intelligence: The New Science of Human Relationships."