If You Don’t Like to Think About AIDS, Don’t Read This.

June 10, 2007

Nicholas Kristof wrote a piece recently entitled “Save the Darfur Puppy.” I think he was going for getting a reaction with the title, and it worked, at least with me. You’ve probably notice that the media loves stories about endangered species–always cute, cuddly ones, never rodents–because people are moved by these stories. On the other hand, a crisis like the genocide in Darfur is unlikely to get airplay commensurate with its magnitude. And likewise with AIDS, which despite being of tragic scale–two or three flaming World Trade Centers full of people dying every day–rarely hits the news, in part because it’s the same old, depressing story, every day.

So, when I saw that Truthdig had an interview called “Stop Ignoring AIDS and Africa,” I gravitated light-wards. The piece is an interview of Stephanie Nolen, the author of a new book called “28: Stories of AIDS in Africa” which tells one narrative of a (real, actual, living and breathing) human being with HIV in Africa for every one million of the estimated 28 million living with the virus. I certainly plan on reading this book, but here’s what really caught my eye–this picture:

And its caption:

Bongos, an 8-year-old HIV-positive boy, waits in a hallway at the Sparrow Rainbow Village medical clinic in Johannesburg, South Africa, in November 2005.

This really hits home, because I volunteered at Sparrow back in 2005. They do incredible work, and my few weeks there were extremely moving. Sparrow is an orphanage and adult hospice–a “village”–where those with HIV are cared for. The corridor in the background is the central part of Sparrow’s administrative center, which connects some of the hospital rooms (for the sickest patients), a kitchen, administrative offices, and even a makeshift morgue. Because most of the patients there receive some level of antiretroviral treatment Sparrow is really, sadly, one of the best places to be in Johannesburg if you’re a kid with HIV.

Here are some compelling quotes from Nolen’s interview on Truthdig:

You show people a picture of one sad-looking puppy and everyone runs for their wallet, and you tell them that 30,000 children die a day of diseases that can be prevented for less than a buck and nobody gives a rat’s ass. I don’t know what it is, what that says about us as a species, but I certainly know from a long time reporting about HIV in Africa that it’s true.

On narrating an issue where the statistics are numbing:

Their lives could not look more different in some ways than the lives of an American or a Canadian. But when you sit down in the little counselor’s booth in Malawi or Lusaka and they say to you, “You have AIDS, you’re going to die,” that doesn’t feel different than it would if you were in America. And it’s getting people to realize that those people had all—sure, they’re Africans—but they had all those same expectations around their lives. They want to graduate from high school, they want to start a little business, they want to, you know, persuade that really cute girl they’ve been eyeing for a long time to go out with them. It isn’t any different. You’ve really got to go, go really micro to make people understand that story, to get them past the numbers.

On finding stories of progress:

You know, I think we get very often this perception of it being a grim story where not very much changes…We also don’t hear that huge progress has been made in responding. There were, for example, when I started reporting on this full-time, there were fewer than 100,000 people on treatments and today there are 1.5 million in Africa. And everybody said, “You can’t do it, there’s no way you can treat in Africa.” Well, that’s a 13-fold increase in four years, and those people have better survival rates on treatment than most Americans on treatment do. So lots of victories.

On money and broken promises and the real roadblock to widespread treatment programs (trained health care professionals):

And there’s a lot more money available than there was….They need about $6.8 billion to meet those proposals, and they have, you know, like, $1.85 in change. Constantly, countries promise money and don’t deliver or don’t promise anything like what’s needed to respond. So we need money. I think, even more than money, these days we’re realizing that there are some more intractable problems that are going to need more creative solutions. So you can use that money to fly in boxes and boxes of pills. You can’t fly in nurses, doctors, pharmacists. I mean, you can fly in a few, but not enough to meet the needs of a whole, continent-wide healthcare program, right?

On the underlying economic inequalities that drive the epidemic:

You know, I meet lots of young women who’ve been given information about HIV but who are selling sex down at truck stops because their parents have died, they’re raising their siblings and that’s the only option that they have. So, you know, they say, “Fine, we’ve been told about HIV in the safe-sex textbooks, but HIV might kill me in five years or 10 years and we’re all going to starve to death next week if I don’t do this.” So, you can address some of the obvious things around prevention, but unless you change the factors that drive people into risky behavior, then you haven’t achieved very much.

And, a bit further afield, but still in Africa, on Darfur and the war in Uganda:

And, you know, it’s also interesting to talk about Darfur because, yeah, there are probably 300, 350,000 dead there and a lot of people displaced, but it is in fact a far smaller conflict than the war in northern Uganda which has been going on for 21 years. You have four times as many people displaced in northern Uganda. You have four times as many people dead. Well, when did we last hear about that one, right? I mean, Darfur is suddenly sexy because George Clooney goes there and, meanwhile, the war in northern Uganda that relies almost entirely on child soldiers … you don’t hear about that one.

On Bush’s PEPFAR program (providing treatment for AIDS in Africa):

Well, you know, I’ve done a lot of call-in radio lately where people call up and are yelling about the Bush administration letting people die, and here they are, spending all these billions of dollars in Iraq. Why don’t they do something in Africa? So I say to people, “Well, guess what? Actually the $15-billion, five-year program to intervene for AIDS in Africa, that the Bush administration dreamed up, has been the single greatest response to the pandemic ever.” And then there’s kind of silence on the end of the phone, you know?

And its problems:

…They’re saying a group that’s going to get U.S. funds to distribute condoms or put AIDS programs in schools or care for sick people, has to sign a piece of paper condemning sex work. And that’s like crazy moral language that just has no place in a place where people are selling sex to eat.

I like Stephanie Nolen. And I like Truthdig.

(If you’d like to learn more about or donate to Sparrow, please do so!)


The Debate (II)

June 4, 2007

Awesome question on Pakistan. Hurray for random history professors in the audience.

Many of these hypothetical situations are ridiculous. Kucinich handled the question about assassinations well. I don’t his answer is very politically wise, but it’s the best thing to say.

Hillary really tries to turn everything back to being Bush’s fault. This certainly plays well to the liberal base, but it doesn’t always make sense.

Biden is really extraordinary on foreign policy. On Sudan: “They have forfeited their sovereignty by committing genocide.” Amen brother. He and Richardson are talking sense on Darfur, and on Africa.

There’s a lot of hand raising going on. Wolf Blitzer is a blithering idiot. And Hillary called him on it.

Chris Dodd: Boycotting the ’08 Olympics in Beijing if China doesn’t get tough with Sudan is “going too far.” Bullshit.

Biden is too angry to be a good politician, but he gets things right.

Obama rocks on talking about American moral legitimacy as a world leader.


The Debate

June 4, 2007

Kucinich has the best solution for health care. Bravo. Any ‘solution’ to America’s health care problems that feed the insurance companies will continue being terribly inefficient, and citizens will blame it all on the Democrats. Universal health care doesn’t have to be a bloated, hodge-podge design we create as go along.

Why does Hillary always sound like she’s shouting?

It’s unfortunate Obama doesn’t sound quite as articulate in the debates as he does in his books. I still like him the most, and have the most confidence in his personal integrity (largely based on his community organizing work).

I’m amazed at how many different ways there are to dodge questions.

I’ll be even more amazed if any of the debaters will admit that pulling out of Iraq will likely lead to much more violence. That’s a fact of life, and one we must come to grips with (I still think we need to move out–we’re just prolonging the inevitable). There are some realities that are simply unmentionable for a politician.

They need to turn of Wolf Blitzer’s mic when he’s not asking questions. That’s just not professional.


The Epitomal Transhumanist

January 19, 2007

This video of Ray Kurzweil (about 23 minutes long) is an excerpt from an annual seminar called TED Talks (for Technology, Entertainment and Design) that features leaders from a variety of fields. While most of the talks seem to focus on society or technology, the perspectives are quite broad: Al Gore, Rick Warren, Daniel Dennett, Bono, and Richard Dawkins have all graced its stage in recent years.

Ray Kurzweil is a prominent transhumanist, and has one of the most optimistic views of technology possible. One of his more recent books is The Singularity is Near, which describes his view that not only is the eventual surpassing of humanity by artificial intelligence inevitable, it is also nearer than we think. In Kurzweil’s view this process will include the merging of our own personal consciousness with the advanced capabilities of computers to eventually be able to process more quickly, analyze more astutely, retrieve data more accurately, and so on. In Kurzweil’s view, what truly distinguishes homo sapiens is not our current biological status, history, or accomplishments, but our impetus to transcend our limitations. Technology merely offers us a new vehicle for our transcendence.

Regardless of whether you embrace his views wholeheartedly (they seem a bit optimistic even for me) or you feel a shiver of terror or silent mockery slipping down your Luddite spine, Kurzweil’s thought should be examined because of his influence. He’s a successful inventor and author, and a prominent figure among futurists and transhumanists. Here’s a summary of sorts of Kurzweil’s TED talk:

Can we predict the future? While certain specifics of technological progress are very hard to predict, overall trends are predictable, and they’re also exponential. Growth in one technology enables and promotes growth in another technology. 50 years to adopt telephones, 8 years to adopt cell phones. TV took decades, but new technologies- like the internet- have taken off much faster.

Kurzweil then makes an analogy to biological evolution. The evolution of genetic material (DNA/RNA) took billions of years, but once certain genes were in place (or the common “tool-kit,” as evo-devo would put it) more rapid (~10 million years) change, like the Cambrian “explosion” (a term that is disliked in many circles) can occur. But as the first technology-creating species, our culture has allowed us to “evolve” on a level that is exponential in comparison to biological evolution (which is one reason we have a hard time understanding evolutionary time scales).

It took tens of thousands of years to develop agriculture, then thousands to move to more centralized forms of government (those two are arguably related, but the direction of causality is disputed), civilization led to quicker technological development, etc. The last 500 years of technological growth were incredible, but the last century has been even more impressive- bringing us widely available automobiles, radios, TVs, airplanes, medical technology, computers, Internet, not to mention space flight and an incredible plethora of new weapons systems with which to butcher each other.

This emphasis on technological development as an exponential process is a major theme of Kurzweil’s work. But, he points out, people always begin doubting when exponential growth for future technology is predicted. This growth is a result of

“worldwide chaotic behavior.. You would think it would be a very erratic process, yet you have a very smooth outcome… Just as we can’t predict what one molecule in a gas will do- it’s hopeless to predict a single molecule- yet we can predict the properties of the whole gas using thermodynamics very accurately. It’s the same thing here- we can’t predict any particular product, but the result of this whole worldwide chaotic, unpredictable activity of competition in the evolutionary process of technology is very predictable, and we can predict these trends very far into the future.”

Kurzweil also talks about the suboptimal nature of much human biology (so much for perfect design). For example, our metabolism, which leads us to hold onto every calorie, is a throwback to our hunter-gatherer days and is something that we might like to modify to prevent obesity in developed nations. And another problem, which seems to be Kurzweil’s main fascination: “Long life spans (as in more than 30) weren’t selected for.”

While some of his examples are sketchier than others, the idea of an engineered erythrocyte (red blood cell) that could increase oxygen capacity greatly is particular interesting. In my view, Kurzweil has a tendency to exaggerate about some possibilities, but then again, exponential growth will always appear as an exaggeration to those in a linear-growth mindset.

I think more important than any individual predictions about technological progress that Kurzweil makes (like reverse-engineering the brain by 2020), his main point stands: the progress of technology throughout history has been accelerating. The main question tends to be whether we’ll be able to harness these technologies to make life more certain, more pleasurable, more equitable, more eco-friendly, and more connected (and therefore more meaningful on some level) or to just wipe each other off the planet.


Obama on Globalization

January 7, 2007

barack obama sweatshop

Before reading Dreams From My Father, I knew that Barack Obama had a Kenyan father and an American mother, and had assumed from that that he would have thought out issues of international relations in greater depth than many American politicians. Reading his book, I was pleasantly surprised. Prior to his multiple trips to Kenya, Obama actually spent about three years living in Indonesia as a child. His time in Jakarta has, at least from some of the thoughts he included, given him a level of healthy skepticism regarding globalization and economic development. Also, for what it’s worth, his degree from Columbia was in international relations.

Based on his experience and study, I think Obama is at least more likely to understand the complexity of international economic developments. The greater question is whether a nuanced view of the effects of particular U.S. foreign policy decisions would really lead to substantively better decisions when he’s placed in a position where the accepted thing to do is to promote U.S. interests (i.e., the presidency, or the U.S. Senate).

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Dreams From My Father

January 6, 2007

160px-senatorbarackobama.jpg

My friend Bethany gave me Barack Obama’s Dreams From My Father: A Story of Race and Inheritance for Christmas. I was deeply grateful, and proceeded to demonstrate my gratitude by reading it over a 3-4 day period. The book was surprisingly long (over 400 pages) yet held my attention strongly throughout. Obama, writing ten years ago after being named the first black editor of the Harvard Law Review, describes the development of his own unique racial identity as the son of an African man and American woman. He uses flowing, descriptive prose that is unsentimental yet thought-provoking, while avoiding many clichés.

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One Person’s Crook

December 10, 2006

Is another person’s Congressman.

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William “Dollar Bill” Jefferson won the run-off election in Louisiana to go back to Congress. In May, the FBI found $90,000 in $10,000 increments, wrapped in aluminum foil, hidden in Jefferson’s freezer, days after he was videotaped taking a briefcase full of cash as a bribe. And some people still think he’s great.

Interestingly, I googled his name, and got the picture above…

With 44 percent of the precincts reporting, Jefferson, Louisiana’s first black congressman since Reconstruction, led with 61 percent of the vote over state Rep. Karen Carter, who had 39 percent.

[Jefferson] described his win as “a great moment and I thank almighty God for making it possible.” He called for regional unity to focus on the hurricane recovery and in bringing back evacuees who are still scattered across the country.

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Quotes for Thought

October 18, 2006

Some quotes to ponder from two of my favorite doctors…

Dr. Jim Kim:

“There are more billionaires today than ever before. We are talking about wealth that we’ve never seen before. And the only time I hear talk of shrinking resources among people like us, among academics, is when we talk about things that have to do with poor people.”

“Farmer got hold of a pamphlet about how to equip labs in third world places published by the World Health Organization. It made modest recommendations. You could make do with only one sink. If it wasn’t easy to arrange for electricity, you could rely on solar power. A homemade solar-powered microscope would serve for most purposes. He threw the booklet away. The first microscope [at Partners in Health’s medical clinic in] Cange was a real one, which he stole from Harvard Medical School. ‘Redistributive justice,’ he’d later say. ‘We were just helping them not to go to hell.'”

Paul Farmer:

“God gives us humans everything we need to flourish, but he’s not the one who’s supposed to divvy up the loot. That charge was laid on us”.

“I recommend the same therapies for all humans with HIV. There is no reason to believe that physiologic responses to therapy will vary across lines of class, culture, race or nationality.”

“In an era of failed development projects, and economic policies gone bad, I sometimes feel very lucky as a physician, since my experience in Haiti has shown me that direct services are not simply a refuge of the weak and visionless, but rather a response to demands for equity and dignity.”

“Shuttling back and forth between what is possible and what is likely to occur is instructive and a lot of what shapes our sentiment.”

“I critique market-based medicine not because I haven’t seen its heights but because I’ve seen its depths.”

“For me, an area of moral clarity is: you’re in front of someone who’s suffering and you have the tools at your disposal to alleviate that suffering or even eradicate it, and you act.”


Partners in Health

October 18, 2006

Boston was amazing. I wrote a report for the group that funded my trip, and I realized it would make a decent blog post. And I got to meet Paul Farmer, who’s basically my hero/role model in many ways. I don’t think it quite qualifies as a “hero” because that implies you idolize the individual. Dr. Farmer is a figure worth looking up to because of his extraordinary work ethic, the good he’s been able to accomplish for global health, and the fact that he is an icon for like-minded individuals.

Partners in Health’s 13th Annual Thomas J. White Symposium was attended by approximately 1500 people–students, volunteers, admirers, and donors of all ages–at the Kresge Auditorium on the campus of MIT in Cambridge, MA. Partners in Health (PIH) is a non-profit organization that has grown over the past two decades to include 4000 employees in Boston, Haiti, Russia, Peru, Guatemala, Rwanda, Lesotho, and soon in Malawi, who last year provided health care to over 1 million people, including 1000 on antiretroviral treatment for HIV. PIH has had a significant impact on global health policy because of the personal dedication of its founders and the principles on which it is founded, which were expressed well by the 2000 People’s Health Assembly in Savar, Bangladesh; “The attainment of the highest possible level of health and well-being is a fundamental human right”.

The symposium, designed to summarize the past year’s activities, and to outline the policy and programmatic struggles to come, began with remarks by Ophelia Dahl, Executive Director of Partners in Health, on the last year’s expansion of PIH�s operations into Rwanda. A video was shown that highlighted the adaptation of clinical models developed in Haiti, incorporating HIV and TB treatment with community health workers and housing support, for Rwanda.

The keynote address was given by Dr. Jim Yong Kim, current head of Harvard’s Division of Social Medicine, and co-author of Women, Poverty, and AIDS. About ten years ago, Dr. Kim and Dr. Paul Farmer, cofounders of PIH, demonstrated the possibility of treating patients with HIV and Multi-drug-resistant Tuberculosis (MDR-TB) in resource-poor settings. Their research findings changed World Health Organization policy, which had previously recommended against treatment in impoverished countries. Dr. Kim recently spent three years in Geneva as the director of the World Health Organization’s AIDS program, where he pioneered a campaign to get 3 million poor patients on HIV treatment by 2005. He spoke of the triumphs and pitfalls of working within the WHO bureaucracy, of which he was previously a well-known critic. While lauding the continuing research into new cures, Dr. Kim also introduced a new program at Harvard Medical School in Global Health Effectiveness, helping to improve worldwide access to therapies currently available in high-income countries.

Dr. Paul Farmer, who has become a minor celebrity to students of international health and development after being featured in Tracy Kidder’s Mountains Beyond Mountains, spoke charismatically about the interconnection of social and economic factors with the health of the poor, and about the continued need for an equity plan to prevent and cure treatable diseases worldwide. He also praised donors like Thomas J. White, the millionaire who made PIH’s early work possible, and in whose honor the annual symposium is held.

Other presenters included Lucette Fetire, a Haitian HIV patient and advocate who told her story of how PIH first treated her, then empowered and employed her as a community health worker to help her HIV+ neighbors. Dr. Ludmilla Kashtanova, director of PIH�s Russian programs, talked of treating MDR-TB in Russian prisons, and changing the course of Russian policy to prevent further spread of the disease. Veronica Suarez Ayala and Jason Villarreal, community health workers for PIH in Peru and Boston respectively, shared stories of their patients, sometime succumbing to disease, and sometimes recovering to help others.

Personally, I found the event extremely affirming and encouraging. Meeting many likeminded undergraduate and medical students was uplifting, and being in a large crowd that affirmed a belief I strongly hold�that people should not die of treatable diseases regardless of their country of birth�only helped crystallize my goals.