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Ebola First World Problems

This is not to minimize the real suffering of the real people who have contended with the real disease in the First World. It is a horrifying disease wherever it occurs.

No, this post is about what I’ve been seeing in the news here. When the disease was limited to Africa, it wasn’t seeing much at all in the US. Thousands died, and there was hardly a blip. What I did see seemed mostly to question whether there was any point in sending medical aid.

Now that there have been about seven cases here (the two Samaritan’s Purse health workers, Thomas Duncan, his two nurses, a freelance journalist in Nebraska, and the Doctors Without Borders physician there’s currently a flap about)– now that there have been cases here, the country is hysterical.

NASA artist's conception of asteroid destroying Earth
(artist unknown. NASA)

A school in Maine put a teacher on administrative leave after parents “expressed concern” — meaning panicked — that she could have been exposed because she visited Dallas with one Ebola patient in quarantine in a hospital that she never visited.

I’ve heard of a caller to emergency services complaining about a pilot running around loose who’d been to West Africa, which later turned out to be the same place in the caller’s small mind as Western Europe. And, yes, that’s funny, but it’s also bad. While that drivel is going on, the dispatcher and the ambulance (they sent out an ambulance?!) can’t respond to actual emergencies.

People of West African extraction are being shunned because, because what? They’re catching it by quantum juju from people 5000 miles away whom they’ve never met? White Africans, interestingly enough don’t seem to be seen as quite as susceptible to magical infection.

Most recently, a bunch of governors saw a great opportunity to get out in front of the hysteria and Doooo Something. Let’s quarantine everybody, sick or not, who’s ever been near West Africa. So when a selfless altruist like Kaci Hickox returns, a woman who’s a nurse for Doctors Without Borders and has treated Ebola patients and actually knows something about the disease, when she returns she becomes a political plaything for Chris Christie and Andrew Cuomo (bipartisanship!) to score points with ignorant voters by dumping her into a senseless quarantine.

Quarantine is for CONTAGIOUS people. It’s a useless waste of money and resources applied to any traveller some bozo happens to have fantasies about. Quarantine can be a medical necessity. It needs to be done on medical grounds. When it’s nothing but jerks lashing out in panic, it’s not only insane, it’s actually counterproductive and increases the spread of disease. (So much for Christie’s and Cuomo’s “leadership.”)

So, that’s the “Keep Calm” part. What about the “Carry On” part?
Are there things that could sensibly be done to help the situation? Why, yes. Yes, there are.

Number One. (This should be in bold all-caps, but I’ve done that already. Must ration myself.) The US needs to get itself an actual healthcare system. Using disease as a profit center for Big Medicine and Big Insurance just isn’t working.

When Thomas Duncan fell ill in Dallas everybody knows what happened next. After his first emergency room visit, he was sent home. Now, note this: Ebola is not contagious until after the patient has run a fever for some time, a day or so, when the virus starts being secreted in body fluids. (The main research paper so far on contagiousness: Bausch et al., 2007. Discussion in Science.)

So if the emergency room had actually worked, he went early enough that there would have been just about no chance he’d been contagious. But the emergency room didn’t work. What hasn’t been mentioned loudly enough is that he had no insurance. Stories about grievously ill uninsured people turned away from emergency rooms in the USA go on forever. There’s even a name for it: “patient dumping.” Some of them die, just like Thomas Duncan. But, this being the First World, most of them aren’t contagious. That was the only part Texas Presbyterian Hospital forgot. They needed a big sign in the physicians’ break room: “CAUTION. Do not kick out patients with incurable contagious diseases! Could have lethal Bad Publicity consequences!”

There’s the first culprit: a profit-oriented “health” system. If we really want to reduce the chances of catching Ebola from random strangers, then we need a health care system that encourages people to get help whenever they feel ill. Nor can it expect them to self-diagnose first so that hospitals see only “real emergencies.” And then the system has to actually treat them for whatever ails them.

Number Two in the list of useful things to do is to help deal with the problem at its source. (In fact, this is Number One, but this post is about first world problems.) They need many things to stem the disease in West Africa: Information distributed everywhere by trusted health workers on how not to transmit the disease. How best to treat ill family members. (There’s a surprising amount that could be done with that, as demonstrated by the knowhow and astonishing strength of the Liberian nurse who took care of her whole family and managed to save most of them.) How to reduce chance of infection. Contact tracing. Enough transport for sick people so they’re not crammed eight to an ambulance. Enough field hospitals and enough beds so contagious patients can be properly cared for.

Would that take money? Yes. But it’s peanuts compared to what it’ll cost if the disease continues to spread. And it’s not as if panic is cheap. (Panic is a total waste, but it’s not cheap.) Would the money have to be spent in Africa? Yes. Get over it.

Notice something about useful actions against Ebola: They involve admitting that fear is not useful. They involve restraining automatic reactions. They involve huge amounts of tedious work. They offer no excuse to lash out at anybody. They’re no fun.

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The worst news about Ebola so far

Eight members of a team trying to raise awareness about Ebola have been killed by villagers using machetes and clubs in Guinea, officials say.

From the BBC.

“[M]any villagers are suspicious of official attempts to combat the disease. … The motive for the killings has not been confirmed, but the BBC’s Makeme Bamba in Guinea’s capital, Conakry, says many villagers accuse the health workers of spreading the disease.

Others still do not believe that the disease exists.

Last month, riots erupted in Nzerekore, 50 km (30 miles) from Wome, after rumours that medics who were disinfecting a market were contaminating people.

When I was a toddler, I was sure the trees made the wind. (They move around, and you feel wind. ‘S obvious, right?) It’s easy to confuse cause and effect when you don’t know anything.

But then you learn. Ignorance is not bliss. Ignorance is hell.

The Witches’ Well near Edinburgh Castle. Commemorates over 300 women burned at the stake there.

 
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Ebola is not Over There

It’s right here on planet Earth.

Current genomic work shows it’s mutating quite rapidly. So far, none of those mutations has changed how it’s transmitted — that is, only by direct physical contact — but high mutation rates in viruses mean you never really know what they’ll be able to do next.

Which is why articles like this, by a doctor affiliated with Stanford University, no less!, are jaw-droppingly stupid. His main point is that there are plenty of lethal and far more widespread diseases such as malaria and AIDS. So when the WHO estimates five hundred million dollars to contain this Ebola outbreak, all that spending would be a waste of money when there are other more pressing priorities.

No. It means that the fights against malaria and HIV are horribly underfunded. Using the atrocious lack of money for one set of diseases as an excuse to ignore another disease is called compounding the error, not solving it.

The consequence will be that Ebola is not contained, that tens of thousands or many more will suffer and die, and (if you’re the sort of person who worries only about yourself) that the virus keeps merrily mutating until one day controlling it may not even be an option. Then, you who felt too safe to worry about it may die no matter how much money you decide is worth spending then.

The consequence is that tremendous people working to actually do something about this awful and incurable disease have to spend their time drumming up funds instead of, you know, working to actually do something about this horrible disease.

The consequence is that people with the stamina to work against hopeless odds, in heat, packed into layers of sealed plastic, because everything they do can change their life to death in one unnoticed heartbeat — the consequence is that those people have to report scenes like this:

The new patients sometimes arrive eight to an ambulance, those with suspected cases and those with probable cases all mixed together.

That increases infections. That increases the number of people needed encased in plastic in the heat to feed and bathe the patients and carry out and disinfect the dead bodies.

The consequence is that we’ll be seeing the following horrors more and more, maybe even right in your face one day, until enough of us realize that hanging on to money is not the most important thing in the world.

Health workers prepare to remove abandoned corpse in Duwala market, Monrovia, Liberia. Aug 17, 2014.
(Reuters/2Tango)

 

Trying to enforce quarantine in West Point, Liberia. Aug. 22, 2014. (Very counterproductive. Quarantine order later lifted.)
(Guardian)

The future is here. It’s just not evenly distributed.

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Nelson Mandela

Nelson Mandela voting in 1994
(Paul Weinberg : Wikimedia)

Usually, when some world leader dies, I don’t care. More often than not I even think, “Well, that’s one less lying mug I’m tired of seeing.”

But with Nelson Mandela I felt a stab of sadness, as if he was my friend.

One of our greats is gone. I wish he’d lived forever. Maybe if we live in ways that honor his work, he will in a way.

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Today in Racist News

First the Russian fans shouting garbage at the black captain for Manchester City. (Once his team was winning, I gather. Bad losers, too.) Yes, Russians can be dreadful racists. That’s not the surprise. For me, the surprise is that even in this day and age the authorities, in this case the people who run the football club whose fans were so horrible, are fine with it. And they’re so tone deaf they say, out loud, “Oh, it wasn’t that bad. Oh, you’re exaggerating.” In other words, shut up and go away. (After a couple of days of pressure, they changed their tune.)

Racism backed by authorities, even authorities who think better of it after the damage is done, needs the strongest possible response. Boycott ‘em. Close the stadium. Stop it now. Go Yaya Touré.

Then there’s the blonde Roma child found in a Greek gypsy camp among the more average darker inhabitants. The immediate reaction was that she must have been kidnapped. Then some DNA evidence showed that the mother is another impoverished Roma from Bulgaria. The talk of kidnapping stopped. The talk about trafficking started. The girl must have been sold.

Yes. Poor people sometimes do appalling things to survive. But poor people also sometimes commit acts of astronomical generosity, inconceivable to those more comfortably situated. One image branded on my mind from history books is starving peasants around the time of the Russian Revolution giving their swaddled infants to strangers on passing trains in the desperate hope the babies might then survive. I don’t know if they lived or not. I don’t know the statistics on how that worked out. But in the moments when it happened, on both sides, there had to be a stunning ability to give everything away.

If it had turned out that some equally blonde people from, say, Iceland were the parents, how quickly would the police assume they’d sold the child?

Never, I expect.

But since she has a Roma mother, well, it’s obvious isn’t it, there’s been a criminally sordid transaction. It’s the first conclusion they come to, not the last. Evidence not needed.

Whatever the evidence does finally show, it doesn’t change the willingness of the (white?) world to jump to racist conclusions without any.

The big difference between them and the Russian fans is that football hooligans yell crap out loud in a stadium.

A nice redskin potato

And then, of course, close to home, the flap in the USA about the Washington Redskins. The name is insulting to American Indians. So change it. It’s a name, fergawdsake. Or, as a commenter pointed out, don’t change it but change the logo to a potato. What an idiotic thing to have to expend energy on. We could be putting all that money and effort and emotion toward mitigating the real damage of racism. Instead it’s going toward arguing over labels with a bunch of neanderthals running one of our autumnal concussion teams.

Then again, maybe that’s easier than dealing with racism.

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What I don’t understand about the Mali fight


From a purely tactical perspective, that is. I keep seeing reports mentioning how the fanatics will melt into the desert and be difficult to root out.

Assuming resources — and I do understand that those are not generally applied — but, assuming resources, I don’t see how the Sahara could shelter them for long.

Water is limiting. Garrison every oasis for six months, and anybody hiding in the Sahara is done for. It’s also the worst place on earth to hide from satellite surveillance. Few clouds, few trees. So if pickup trucks start driving to camps in suddenly larger numbers, it could be visible. Assuming anyone used their satellites to look.

I get that fanatics can hide now and have hidden in the past because it’s a vast trackless area, you have to know the terrain, the regional governments don’t have or don’t devote the resources to it, etc., etc.

But it seems to me that right now there’s an opening to get the local knowledge. The Tuaregs are mighty pissed off with everyone, especially the fanatics who stole their revolution. They’re some of the most skilled desert dwellers there are. So give them Azawad, where they can run their own internal affairs, within a federated nation of Mali, where they can be part of a more viable economic unit, and give them the military data they need to wreak vengeance on the even more unsavory fundies.

If we believe in self-determination like we say we do, the first part is a worthy goal in itself. And for military effectiveness, I’d be willing to bet you couldn’t beat the second part.


Update, 2012-02-07. From McClatchy: “Aklinine Ag Bogali, who spent years traversing his desert homeland in northern Mali, described some of the caves there as so large that they open onto underground lakes.”

Oh.

Although it does confirm what I was saying about the local knowledge of the Touareg.


The Unseen

This picture hit me. Like a wet fish slapped in my face.

It’s part of a BBC photoessay about the poorest of boys in Nigeria finding something to love in their lives in the game of football (what the US calls soccer).

Nothing wrong with that. Good for them!

But this was the second picture in the series:

Group of boys playing on a grubby slum street. They and the photographer are oblivious to the woman passing within a few inches of them, a black-shrouded ghost

What I saw was this:

Moves the point of view halfway to the woman

Focuses on the woman

The caption says nothing about the black-shrouded ghost in the picture. She’s closer than a hand’s breadth away from the nearest boys because she’s trying to stay on the dirt road and out of the open sewer that is the gutter. They don’t seem to see her. They don’t give her any space. She doesn’t ask for any. She doesn’t exist.

Nor does the photographer see her. “Ibadan’s youngsters file into teams wearing different jerseys.” (No. Ibadan’s boys file into teams.) “Their goal is simple. … [T]o improve their standard of living and that of their families.” “Akeeb Kareem, chairman of Ibadan’s Sango Community Youth Forum, says the street game is invaluable in keeping the city’s young men constructively occupied.” But the woman, swaddled in black when it’s sweltering, couldn’t play outside even if such an idea occurred to her. Nobody’s worrying about how to make it easier for her to be constructively occupied. She already is, carrying a bag of food home, by the look of it.

Women do nearly three quarters of the work in sub-Saharan Africa. It’s good that the boys are trying to beat poverty. If that’s good, the people already doing 70% of the work to help their families are even more worthy of focus. Helping them in their constructive occupations will lead to even better results. Assuming anyone is interested in results.

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An Open Letter to the Left on Libya, Seconded

I’ve been trying to articulate why the intervention in Libya against Qaddafi is a good thing. And why the reflexive rejection of it as an imperialist oil grab is just that: some kind of reflex, not thought through.

Luckily, Juan Cole has expressed it much better than I could have, and on the basis of a much broader and deeper knowledge of the situation.

From his closing paragraph, after he’s laid out all the reasons why:

I would like to urge the Left to learn to chew gum and walk at the same time. It is possible to reason our way through, on a case-by-case basis, to an ethical … position that supports the ordinary folk in their travails in places like Libya.

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Women Don’t Need Their Own Revolution


Mary Rogers has made one of the saddest statements I’ve read on the horrible treatment of CNN’s Lara Logan. The gut-wrenching sexism of some of the commentary is sad. One more reminder that we’ve indeed “come a long way, baby.” A long way backward. That such commentary is considered normal — crude, but normal — is sadder. We should, by now, be in a place where it’s unacceptable to think such crap, let alone say it. But the saddest thing of all is a sentence in her article about the crime.

She knows the situation.

If you are a woman living in Cairo, chances are you have been sexually harassed. It happens on the streets, on crowded buses, in the workplace, in schools, and even in a doctor’s office. … 98 percent of foreign women and 83 percent of Egyptian women have been sexually harassed. [That's the number who would acknowledge they'd been harassed.] … what happened in 1994, shortly after I moved here. … A man walked up to me, reached out, and casually grabbed my breast.

In a flash, I understood what the expression to “see red” meant. … But the satisfaction of striking back quickly dissipated. By the time I walked away, I was feeling dirty and humiliated. After a couple of years enduring this kind harassment, I pretty much stopped walking to and from work.

Of course, harassment comes in many forms. … At times it can be dangerous. … I was walking on the street, when a car came hurtling towards me. Aiming for me!

… women who have been sexually harassed here have been too afraid or ashamed to speak up.

Any woman who’s not in denial doesn’t need to have the situation explained to her. For those men who don’t get it, try this thought experiment. You live in a world where you’re only allowed to go outside naked. No way to hide erections. No way to hide the fact that you’re male. Then, because you’re male, it’s an understood thing that anyone on the street can grab your ass, or poke an umbrella between your legs, or laugh when you double up in pain.

That is not sexy. That is not normal. That is not women expressing their hormones.

It’s a power trip. That’s all. It’s saying, “I’ll put you down because I can. And if you don’t hide, I’ll do it again.”

So, like Mary Rogers, you stop walking to work. You may have rights on paper, but you can only go where you’re allowed to go or people can grope your penis any time they feel like it. (No, you can’t just beat them up. The uppity sometimes get their bits sliced off.) Without freedom of movement, your whole world is limited. There are jobs you can’t do, raises you won’t get, recognition you’ll never see. The price of hiding is that nobody knows you’re there. The price of being a target is that you have no actual rights, no matter what it says on paper.

And don’t forget, being a man, you have to tough it out and pretend none of it matters. If you stop hiding, the humiliation will get worse. Much worse.

One more thing: being a man, you represent half the population.

With all that in mind, I come to the saddest thing Rogers said.

A law regarding sexual harassment will have to wait. The country has greater concerns now — forming a new government; writing a new constitution….

Greater concerns? Greater concerns than the basic human rights of half the human race? Say what?

What chance is there anyone’s going to get it, if even people who aren’t in denial can’t figure out which way is up?

Until people understand what human rights are, they can write constitutions till they’re blue in the face and it’ll just be sound and fury, signifying nothing. After the next round of kleptocrats, they can do it again, and it’ll still signify nothing.

The headline of Rogers’ article is “Egypt’s harassed women need their own revolution.” No, they don’t. The people who need it, of any gender, are the ones who think human rights don’t matter enough to put first.

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Congratulations to Egypt! … But …

Now comes the hard part.

Mohammed El-Baradei talked about the “joy and happiness of every Egyptian at the restoration of our humanity and our freedom.”

Unfortunately, no. The regime is out. The restoration is yet to happen. If the Egyptians manage that, too, then I’ll be really exhilarated. Maybe then they can show us how to do it.

Meanwhile, I’m hoping and hoping that the parking on the left doesn’t just turn into parking on the right.

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Out of Africa: Financial Innovation

We’ve made the world a depressing place. Everywhere you look, all the good stuff is buried under a thick and powerful layer of crud. Sort of like an endless mall parking lot. Seedlings push through it every now and again. You can’t even see them from a distance and if you stepped on them, they’d be dead. But you know how it is with seedlings. In time they’re going to destroy the whole damn lot. What follows is one of those seedlings. Keep an eye on it.

Africa pioneers mobile bank push

Mobile financial services in the developing world could be worth $5bn by 2012, say analysts. . . . More than one billion people in the developing world have access to a mobile phone, but no bank account. . . . [CGAP] also expected more than one in five to use their mobile to access banking services, creating a market worth up to $5bn (£3.05bn). . . .

One of Africa’s first mobile banking system[s], M-Pesa, launched in Kenya in March 2007. A network of more than 7,000 agents – mostly shopkeepers – was set up to take deposits and issue cash, with users authorising payments on their mobile phone using a Pin code. That service has now expanded to include Tanzania and Afghanistan with plans to launch in India, Egypt and South Africa.

If we can keep this out of PayPal’s grubby monopolistic mitts, maybe some of this newfangled convenience could trickle all the way down to us. It should go without saying that we, and the rest of the world, will have to do some serious anti-spam and anti-fraud work as this gets more widespread. But you know what? That’s doable.

(Personal note: I’m back from vacation, hiatus, and general out-of-the-loopiness. Sort of. I may become loopy any time again so long as the weather is nice. And it’s always nice here in sunny Southern California.)

mobile banking, microfinance, Africa

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Could we have more like Mukwege, please?

An AP story, via the BBC and congogirl

A doctor from the Democratic Republic of Congo who treats women raped by combatants in the war-torn country has been named “African of the Year”. . . .

“I am pleased to accept this award if it will highlight the situation of women in eastern Democratic Republic of Congo,” [he said]. . . .

Denis Mukwege, 53, who runs a clinic in Bukavu, has said all sides have “declared women their common enemy”.

He says his award from the Nigerian Daily Trust paper of $20,000 (£13,700) will be used to fund a centre to help rape victims rejoin society. . . . [In early January] Dr Mukwege was awarded the Olof Palme prize, awarded for outstanding achievement in promoting peace. . . .

His clinic receives an average of 10 new patients every day.

Women in DR Congo are often raped and subjected to terrible violence by armed men as part of the decade-old conflict.

The Panzi hospital helps women with the physical and psychological injuries after being attacked.

It also provides help for women who have contracted HIV/Aids from their attackers.

A third of patents undergo major surgery.

I don’t have anything to add. I just wish the world was all people like him.

Technorati Tags: Mukwege, women, Congo

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Reporting on Kenya is incomprehensible

I don’t get it. This is from the NYTimes:

Michael E. Ranneberger, the [US] ambassador … said that his chief concern was whether Mwai Kibaki, the president, and Raila Odinga, the top opposition leader, were “prepared to rise above themselves and put the interests of the nation ahead of their own personal or their group’s political interest.” … The politicians need to sit down and compromise, the ambassador added, because “we’re in the middle of a very serious crisis.”

It has been four weeks since Kenyans went to the polls in record numbers, and the country is still reeling from the aftershocks of a disputed tally in which Mr. Kibaki was declared the winner over Mr. Odinga, despite widespread evidence of vote rigging.

So, let me get this straight. The election is known to be stolen … but the two sides need to “compromise” for the good of the country.

What do they think Kenya is? The US in 2004?

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Hero Rats

I came across this great story on Ars Technica.

Trained rats sniff out unexploded mines. They’re smart, calm, and light enough not to set the horrible things off. And cheap, compared to the $25,000 invested in a trained dog. A Belgian outfit called Apopo came up with the idea and has been training the rats, a special, six-pound, African species. It takes about a year, and one in four “graduates.”

Thousands of children and farmers would not lose legs, hands, eyes, or their lives if these animals could be deployed everywhere they’re needed.

Oh, and did I mention that they’re seriously cute?

African giant pouched rat hunting for mines in a farm field

Not only would lives be saved, hundreds of square miles of farmland could be returned to production if the explosives were cleared.

The rats can be trained for any work that requires a sensitive nose, such as TB scanning, as well as other diseases. Imagine it. Each health worker with her or his own little pet carrier.

The hardest part, I gather, has been getting people to fund work with rats.

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The world is (not) growing safer

You’d think a bunch of biblical literalists, or whatever the hell they are, would have at least read the book they’re always swearing by. Haven’t they heard about “sowing the wind, and reaping the whirlwind”?

Words fail me, and the information really needs to go viral, so I’ll just quote Andrew Heavens mindboggling post:

August 29, 2007

the scariest headline of the week award goes to … today’s Khartoum Monitor:

DRIVE FOR NUCLEAR REACTORS POSSESSION

In a scientific symposium yesterday at the Islamic Jurisprudence complex, participants said it is essential to establish research centres and installations in the fields of physics, chemistry and physical engineering which will enhance atomic and nuclear research…

Scientists recommended a drive to obtain mass destruction weapons and that if the enemy is suspected to be in possession of these weapons, we must get prepared and be trained in their use.

Just what Sudan needs. And who is “the enemy”?

The point is not that terrorists could get at these weapons. The point is not even that Sudan will waste resources getting a nuke or two. (Although both are big issues.) The point is that they want nukes.

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