Monday, June 25, 2007

Where Are the Doctors?

Nicholas Kristof's, two traveling companions in Africa, are producing some excellent entries in their blog, including this one, which hits upon the lack of medical infrastructure and the associated brain drain of physicians in Africa. When I was in Nigeria year before last, one of the medical chiefs at the ECWA hospital in Jos estimated that at least 1/3 of his graduating class had emigrated (mostly to Europe). This excellent post articulates the many reasons for the brain drain.In ophhlmology, there is about 1 eyeMD/million population vs 1/10,000 in the U.S...

“Can you take me back to the U.S. with you?”

Dr. Rudasingwa loves his country. He also cares about his own future. He wants to pursue specialty training in neurosurgery, which is not available in Rwanda. Everyday, he sees patients who need brain surgery, heart surgery, chemotherapy, or other specialized treatments to survive. There is no doctor who can provide these treatments. The best he can do is to watch the patients die. The only person he was able to “save” recently was a high-level official who was airlifted to South Africa after a head injury.

The problems with health care access in Africa are often attributed to lack of resources, but a more insidious and perhaps more difficult problem is the dearth of doctors.

Africa is facing a severe crisis of doctor shortage, on a scale almost imaginable in the U.S. and Western Europe. Rwanda, a country with 10 million people, has about 500 doctors — a ratio of one doctor per 20,000 people. This is less than 10 percent of the World Health Organization recommendation. The vast majority of the country will not see a physician in their lifetimes. The Congo and Burundi have similarly poor ratios. Suburban U.S. hospitals could have more than 200 doctors on staff, while in Burundi, 165 doctors serve 8 million people.

Saturday, June 23, 2007

To be schooled by Segovia

This is a video in which a currently very famous guitarist, Michael Chapdelaine (who has won both national classical and fingerstyle guiarist competitions) goes to a masterclass with Segovia--very enlightening indeed!

Thursday, June 21, 2007

When Is a Pain Doctor a Drug Pusher?

And they call it a "Justice" system--unbelievable story....

Ronald McIver is a prisoner in a medium-security federal compound in Butner, N.C. He is 63 years old, of medium height and overweight, with a white Santa Claus beard, white hair and a calm, direct and intelligent manner. He is serving 30 years for drug trafficking, and so will likely live there the rest of his life. McIver (pronounced mi-KEE-ver) has not been convicted of drug trafficking in the classic sense. He is a doctor who for years treated patients suffering from chronic pain.

Prosecutors are in essence pressing jurors to decide whether an extra 40 milligrams every four hours or a failure to X-ray is enough to send a doctor to prison for the rest of his life. One doctor, Frank Fisher, was arrested on charges that included the death of a patient taking opioids — who died as a passenger in a car accident. A Florida doctor, James Graves, is serving 63 years for charges including manslaughter after four patients overdosed on OxyContin he prescribed — all either crushed and injected their OxyContin or mixed it with alcohol or other drugs. “A lot of doctors are looking for safe harbor,” Caverly said. “They want to know as long as they do A, B, C, D or E, they’re O.K.”

A Student, a Teacher and a Glimpse of War

Kristof's latest from the Congo...

There was nothing special about Yohanita except that she was in front of us. In villages throughout the region, people just like her are dying by the thousands — of a deadly mixture of war and poverty.

Instead of spending a few hundred dollars trying to save Yohanita, who might die anyway, we could spend that money buying vaccines or mosquito nets to save a far larger number of children in other villages.

And yet — how can you walk away from a human being who will surely die if you do so?


What almost killed Yohanita was starvation in a narrow sense, but more broadly she is one more victim of the warfare that has already claimed four million lives in Congo since 1998. Even 21st-century wars like Congo’s — the most lethal conflict since World War II — kill the old-fashioned way, by starving people or exposing them to disease.

That’s what makes wars in the developing world so deadly, for they kill not only with guns and machetes but also in much greater numbers with diarrhea, malaria, AIDS and malnutrition.

ne measure of the international indifference is the shortage of aid groups here: Neighboring Rwanda, which is booming economically, is full of aid workers. But this area of eastern Congo is far needier and yet is home to hardly any aid groups. World Vision is one of the very few American groups active here in the North Kivu area.

Just imagine that four million Americans or Europeans had been killed in a war, and that white families were starving to death as a result of that war. The victims in isolated villages here in Congo, like Yohanita, may be black and poor and anonymous, but that should make this war in Congo no less an international priority.

Carmela Got Gold Jewelry. Hillary Wants a White House.

The New York Times satirist, Maureen Dowd, on Hilary Clinton's recently revealed campaign song...

The satire was a video on Hillary’s Web site to whip up attention for the winner of her online contest to choose a campaign song.

nfortunately, the winner, “You and I,” is definitely not for you and me. (I look forward to Obama’s new campaign ditty, “I Am Thou.”) It doesn’t bode well for the cultural health of the country that Hillary picked a song by Celine Dion, who combines the worst of Vegas and Canada.

Tuesday, June 19, 2007

Here to Take Your Order (and Biting Their Tongues)

The decline of American culture through the eyes of waitstaff...

When I began researching “Hey, Waitress!,” I had two inklings. One was that waitresses, among the underheard icons of America, would have many important things to say about their work. That inkling proved true. The second inkling was that they might challenge a revered notion: that the United States of America is essentially classless.

Challenge the notion? They obliterated it.

“I had this guy the other day say to me, ‘Are you ready to take my order?’ Because is not your existence to serve and take orders?” recalled one waitress at a seafood restaurant in Kennebunkport, Me.

“What do you want? Eye contact?” an impatient man asked another waitress, who had offered to recite the specials and was waiting for his response. The scene took place at an excellent restaurant in Seattle.

Patterns: Aspirin Linked to Lower Risk of Cancer and Heart Disease

Regular aspirin use may significantly reduce the incidence of both cancer and heart disease, according to a large new study, but other nonsteroidal anti-inflammatory drugs, or Nsaids, have no effect.

Monday, June 18, 2007

Rwanda, Past and Present

This blog post from Kristof's traveling companions in Rwanda highlights the leadership of President Kagazme

In 1994, Rwanda was the scene of killings at a rate of 10,000 people per day, and bludgeoned bodies literally lined the streets. When the Rwandan Patriotic Front (the current government of Rwanda) took over, they found dead people, moribund services, crumbled houses, and decimated hospitals. Latrines and lakes were stuffed with bodies, and churches were filled by the bodies of thousands of parishioners whose killings were facilitated by their own ministers. There was no government to speak of.

The successes of rebuilding and reconciliation post-genocide are in no small part due to the vision of President Paul Kagame, whom we interviewed today. A lanky and soft-spoken man, President Kagame has an unassuming yet imposing presence. He is thoughtful, and presents a clear vision for Rwanda. Reputed to read the Harvard Business Review regularly, he believes in economic development as the key to reducing poverty and advancing Rwanda. “We are not in position to turn down aid, but we know that aid is not end in itself. Trade is undoubtedly more importantly.” He is critical of he calls the culture of dependency in Rwanda. “There is a tendency to blame others for what happened. But this will not work. We need to find a way forward for ourselves. We need to work to develop a culture of integrity peace, and hard work. People may not think this can be done. But let’s show they what is possible, and then do it.”

Dinner With a Warlord

Mr. Kristof sits down to dinner with a government labeled "warlord..."

We see war coming,” Mr. Nkunda said, and he pulled out his laptop to show a map indicating that various government-backed forces are being dispatched to attack him. He added: “The only reply to war and ammunition is war and ammunition.”

I told him — a bit nervously — that such tribalism and fighting has torn apart a country that should be one of Africa’s richest. But Mr. Nkunda, who quotes Gandhi, emphasized that what counts here is simply force. “You go by strength,” he said.

There are no easy solutions here, although some steps are essential: supporting professional training and reform of the Congolese security forces, pressuring neighboring Rwanda to support central authority over the full country, bolstering the peace process, and interdicting mineral exports that finance rebel armies. But the most important step is simply for the international community to acknowledge that a war that costs four million lives must be an international priority, even if the victims aren’t staring at us from television screens.

Kristof's two guests on t trip have their own blog ...

The Women of Rwandaa

“They kept raping me, even though I had maggots crawling out of me.

Claudine Mukakarisa, a 27-year old Rwandan woman, was recounting her life. Born in a Tutsi family of 12 children in the southern city of Butare, Claudine went to Kigali in 1993 to look for her sister, who had been taken there forcibly by the Interahamwe (the Interahamwe was the militia group who were the perpetrators of the genocide.) Claudine was 14. She found her sister, but ended up getting caught by the Interahamwe too. For the next year, she and her sister were tied up and continually violated by the soldiers, one after the other. “We became their sexual slaves,” she said, “Men would just come in and do what they like.” They were assaulted so much that they developed wounds all over. “We started rotting. We had wounds in our reproductive areas. Maggots were crawling out of our reproductive organs.”

When the Interahamwe cut off her sister’s leg, Claudine thought she no longer wanted to live. The sisters decided to escape by tying the remaining leg of the sister to Claudine’s leg, and managed to crawl to the edge of the lake. However, they could not commit suicide: the lake was already filled with dead bodies. This was 1994, and the genocide had begun. The Interahamwe caught up with them soon after, and while Claudine was able to escape, her sister was not. Claudine saw her die in front of her eyes.

Sunday, June 17, 2007

Eye flickers key for fine detail

Tiny, involuntary movements made by our eyes when we focus on something could be more useful than we might think, scientists have found.
We may not be aware that our eyes are making these movements, but without them our vision fades.

And scientists have now found that they could also be important in helping us to see very fine details.

The research, carried out by scientists at Boston University, was published in the journal Nature.

Saturday, June 16, 2007

Diagnosis: Conflict of Interest

While those criticisms have merit, there is another culprit: the transformation of continuing medical education into an enterprise for drug marketing. The chore of teaching doctors how to practice medicine has been handed to the pharmaceutical industry. As a result, dangerous side effects are rarely on the curriculum.

According to the most recent data available from the national organization in charge of accrediting the courses, drug-industry financing of continuing medical education has nearly quadrupled since 1998, from $302 million to $1.12 billion. Half of all continuing medical education courses in the United States are now paid for by drug companies, up from a third a decade ago. Because pharmaceutical companies now set much of the agenda for what doctors learn about drugs, crucial information about potential drug dangers is played down, to the detriment of patient care.

Thursday, June 14, 2007

Africa’s World War

Mr. Kristof is in Rwanda with a teacher and a med student from the States. Here he hits on an essential point of the efficacy of timely,outside military intervention in local conflicts...

Mr. Collier, a former research director of the World Bank, notes that when the G-8 countries talk about helping Africa, they overwhelmingly focus just on foreign aid. Sure, aid has a role to play, but it’s pointless to build clinics when rebel groups are running around burning towns and shooting doctors.

One essential kind of help that the West can provide — but one that is rarely talked about — is Western military assistance in squashing rebellions, genocides and civil wars, or in protecting good governments from insurrections.
The average civil war costs $64 billion, yet could often be suppressed in its early stages for very modest sums. The British military intervention in Sierra Leone easily ended a savage war and was enthusiastically welcomed by local people — and, as a financial investment, achieved benefits worth 30 times the cost.

Josh Ruxin, a Columbia University public health expert living in Rwanda, notes that a modest Western force could have stopped the genocide in 1994 — or, afterward, rooted out Hutu extremists who fled to Congo and dragged that country into a civil war that has cost millions of lives.
So it’s time for the G-8 countries to conceive of foreign aid more broadly — not just to build hospitals and schools, but also to work with the African Union to provide security in areas that have been ravaged by rebellion and war. A starting point would be a serious effort to confront genocide in Darfur — and at least an international force to prop up Chad and Central African Republic, rather than allow Africa to tumble into its second world war.

Wednesday, June 13, 2007

What do Saudi Arabia and the United States Have in Common?

Over at the very, very compelling Strange Maps site (warning: do not click unless you have an hour to kill) is a map of the U.S. with each state renamed for a country with a similar GDP.
(via Freakonomics blog)

TimesSelect Between Dust and Deliverance

Friedman hits the nail squarely on the head in this analysis...

But who offers a way forward? Right now the best Arabs can hope for are the decent, modernizing monarchies, like Jordan, Qatar, Dubai and the United Arab Emirates. I do not see any secular progressivism — a Fourth Way — emerging in the big Arab states like Egypt, Syria, Algeria and Iraq, that is, a progressivism that would effectively promote more rule of law, global integration, multiparty elections, women’s empowerment and modern education to lay the foundations of decent governance.
Far from it, Egypt had an election in 2005, and Ayman Nour, the candidate who dared to run against President Mubarak, got thrown in jail on phony charges.

“Sadly,” observed Middle East analyst Fawaz A. Gerges, in a recent essay on YaleGlobal Online, “mainstream Islamists have provided neither vision nor initiative to build a broad alliance of social forces and transform the political space. They arm themselves with vacuous slogans like ‘Islam is the solution.’ ” No wonder, he adds, that the average Arab citizen is fed up today with both their rulers and the opposition, “who promised heaven and delivered dust.”

But since the Islamic parties have monopolized the mosques and the authoritarian regimes have monopolized the public square, anyone trying to articulate an Arab Fourth Way today “is competing against either God or the state — and between God and the state, what room is left for secular democrats?” asked Palestinian pollster Khalil Shikaki.

Only weeds can grow there — small nihilist weeds, like Fatah al Islam in Lebanon or Al Qaeda in Mesopotamia in Iraq or Islamic Jihad in Gaza. And they are growing.

Monday, June 11, 2007

Land of Plenty

Ever since mass affluence, a phenomenon without precedent in the human story, exploded upon postwar America, social and political theorists have wondered, and worried, about the moral and even the spiritual consequences of material conditions. Putting scarcity behind us has been pleasant, but has it been good for us — meaning good for our souls?


It took confidence for Brink Lindsey, of the libertarian Cato Institute in Washington, to venture onto this well-plowed ground with “The Age of Abundance: How Prosperity Transformed America’s Politics and Culture.” This constantly stimulating book vindicates that confidence. His thesis, stated ironically with Karl Marx’s categories, is that in the second half of the 20th century, America left the “realm of necessity” and entered the “realm of freedom.” Americans “live on the far side of a great fault line” separating them from all prior human experience.

“Americans,” Lindsey writes, “have become a different kind of people,” transformed by capitalism’s fecundity. Although often “derided for its superficial banality,” materialism has resulted in “a flood tide of spiritual yearning.”Various scolds and worrywarts have exclaimed, with Wordsworth, that “getting and spending, we lay waste our powers.” To such Jeremiahs, Lindsey provides an essentially cheerful, although not altogether so, counterpoint: affluence has made America a more libertarian, and hence a nicer, place.

The Class-Consciousness Raiser

It may be that the only people with abiding faith in the power of class divisions in America are the country’s few remaining Marxists and Ruby Payne. And while Payne may not believe in class struggle, per se, she does believe that there is widespread misunderstanding among the classes — and more than ever, she says, the class that bears the cost of that misunderstanding is the poor. In schools, particularly, where poor students often find themselves assigned to middle-class teachers, class cluelessness is rampant.

Your class, Payne says, determines everything: your eating habits, your speech patterns, your family relations. It is possible to move out of the class you were born into, either up or down, she says, but the transition almost always means a great disruption to your sense of self.
And you can ascend the class ladder only if you are willing to sacrifice many of your relationships and most of your values — and only if you first devote yourself to careful study of the hidden rules of the class you hope to enter.

Sunday, June 10, 2007

In Saudi Arabia, a view from behind the veil

This former Cairo Bureau Chief for the L.A. Times does a great job in giving a snapshot of what it is like for a Western woman to reside in Saudi.

As a woman in the male-dominated kingdom, Times reporter Megan Stack quietly fumed beneath her abaya. Even beyond its borders, her experience taints her perception of the sexes.

Riyadh, Saudi Arabia — THE hem of my heavy Islamic cloak trailed over floors that glistened like ice. I walked faster, my eyes fixed on a familiar, green icon. I hadn't seen a Starbucks in months, but there it was, tucked into a corner of a fancy shopping mall in the Saudi capital. After all those bitter little cups of sludgy Arabic coffee, here at last was an improbable snippet of home — caffeinated, comforting, American.

I wandered into the shop, filling my lungs with the rich wafts of coffee. The man behind the counter gave me a bemused look; his eyes flickered. I asked for a latte. He shrugged, the milk steamer whined, and he handed over the brimming paper cup. I turned my back on his uneasy face.

Crossing the cafe, I felt the hard stares of Saudi men. A few of them stopped talking as I walked by and watched me pass. Them, too, I ignored. Finally, coffee in hand, I sank into the sumptuous lap of an overstuffed armchair.

"Excuse me," hissed the voice in my ear. "You can't sit here." The man from the counter had appeared at my elbow. He was glaring.

"Excuse me?" I blinked a few times.

"Emmm," he drew his discomfort into a long syllable, his brows knitted. "You cannot stay here."

"What? Uh … why?"

Then he said it: "Men only."

I'm leaving the Middle East now, closing up years spent covering the fighting and fallout that have swept the region since Sept. 11. Of all the strange, scary and joyful experiences of the past years, my time covering Saudi Arabia remains among the most jarring.

In the West, there's a tendency to treat Saudi Arabia as a remote land, utterly removed from our lives. But it's not very far from us, nor are we as different as we might like to think. Saudi Arabia is a center of ideas and commerce, an important ally to the United States, the heartland of a major world religion. It is a highly industrialized, ultramodern home to expatriates from all over the world, including Americans who live in lush gated compounds with swimming pools, drink illegal glasses of bathtub gin and speak glowingly of the glorious desert and the famous hospitality of Saudis.

The rules are different here. The same U.S. government that heightened public outrage against the Taliban by decrying the mistreatment of Afghan women prizes the oil-slicked Saudi friendship and even offers wan praise for Saudi elections in which women are banned from voting. All U.S. fast-food franchises operating here, not just Starbucks, make women stand in separate lines. U.S.-owned hotels don't let women check in without a letter from a company vouching for her ability to pay; women checking into hotels alone have long been regarded as prostitutes.

As I roamed in and out of Saudi Arabia, the abaya, or Islamic robe, eventually became the symbol of those shifting rules.

The sleeves, the length of it, always felt foreign, at first. But it never took long to work its alchemy, to plant the insecurity. After a day or two, the notion of appearing without the robe felt shocking. Stripped of the layers of curve-smothering cloth, my ordinary clothes suddenly felt revealing, even garish. To me, the abaya implied that a woman's body is a distraction and an interruption, a thing that must be hidden from view lest it haul the society into vice and disarray. The simple act of wearing the robe implanted that self-consciousness by osmosis.
DRIVING to the airport, I felt the kingdom slipping off behind me, the flat emptiness of its deserts, the buildings that rear toward the sky, encased in mirrored glass, blank under a blaring sun. All the hints of a private life I have never seen. Saudis are bred from the desert; they find life in what looks empty to me.

Even if I were Saudi, would I understand it? I remember the government spokesman, Mansour Turki, who said to me: "Being a Saudi doesn't mean you see every face of Saudi society. Saudi men don't understand how Saudi women think. They have no idea, actually. Even my own family, my own mother or sister, she won't talk to me honestly."
Then I was just standing there, feeling stripped in my jeans and blouse. My limbs felt light, and modesty flashed through me. I was aware of the skin of my wrists and forearms, the triangle of naked neck. I scanned the eyes behind me, looking for a challenge. But none came. The Saudi passengers had watched my tantrum impassively.

I sat down, leaned back and breathed. This moment, it seems, is always the same. I take the abaya off, expecting to feel liberated. But somehow, it always feels like defeat.

Friday, June 08, 2007

G-8 Summit Winds Down With Africa Aid Pledge

HEILIGENDAMM, Germany, June 8 — As the Group of 8 summit meeting moved toward a conclusion, leaders reaffirmed a 2005 pledge of $60 billion to counter HIV and other illnesses in Africa, but did not set any new deadlines for delivering the aid.

But critics dismissed today’s AIDS announcement, saying that little progress was actually made.

"I am exasperated," Bono, the activist rock star, told Reuters. "I think it is deliberately the language of obfuscation. It is deliberately misleading."

Collins Magalasi of ActionAids said the pledges were little more than “last-minute face saving measures,” according to Reuters.

Monday, June 04, 2007

I Had a Home in Africa

I have many friends from Zimbabwea who could write similar memoirs...sadly...

'When a Crocodile Eats the Sun' is a haunting memoir of Zimbabwe, and a lesson for the rest of us.

The question of whether a white African is an ideal or an oxymoron goes to the heart of one of the world's most difficult problems: can ethnic strife ever be stopped?

Prescription Drugs: Where's the Free Market?

...Such abuses should not be surprising to anyone who appreciates the value of a competitive market. The root cause of all of these problems is government-granted patent monopolies that allow the pharmaceutical industry to sell drugs at prices that can exceed the cost of production by a factor of a hundred, or more. Last fall, Wal-Mart began selling hundreds of generic drugs for $4 per prescription. The vast majority of brand drugs could also be profitably sold for $4 per prescription, if it were not for the patent monopoly granted by the government.

As a result of patent monopolies, drug companies can sell drugs for hundreds of dollars that cost them a few dollars to manufacture. This situation invites the sort of corruption that NYT documents regularly in its pages.

Drug patents do serve a purpose: they provide an incentive to the industry to develop new drugs. However, there are other ways in which this research can be financed. The federal government already spends nearly $30 billion a year on biomedical research conducted through the National Institutes of Health. By doubling this amount, it could probably replace the research conducted by the pharmaceutical industry, most of which currently goes to develop copycat drugs (another problem of the patent system).

As another possible alternative, Nobel Laureate Joe Stiglitz has suggested a prize system, in which the government would buy out patents at prices determined by their usefulness. The patents would then be placed in the public domain so that all new drugs could be sold as generics.

Poker for Darfur!

An opportunity for DocFreeze!!!!

Actor Don Cheadle and poker star Annie Duke asked themselves how they could use their passion for poker to raise money and public awareness of the humanitarian crisis in Darfur, Sudan. What they came up with is the first annual [sic] Ante Up for Africa, No-Limit Texas Hold’em Tournament, which they’ll be hosting in Las Vegas on July 5, in association with the World Series of Poker.

ker with some of the biggest stars from the worlds of poker, sports and entertainment. Cheadle’s Ocean’s Thirteen co-stars George Clooney, Matt Damon and Brad Pitt are among the celebrities who have already committed to play. (Learn more about their partnership with the IRC here.)

You’ll be asked to donate 50% of your winnings to the event’s designated charities, the advocacy group Enough and the IRC, which provides life-saving assistance to the people of Darfur. That donation is 100% tax-deductible.
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