An American Accent in Sydney

"America might control the world, but we must control and keep our own language" -Queensland, Australia's premier

The iconic Sydney opera house is a distinctly Australian image and manages to capture the personality and spirit of both the city and country. Australian identity, like all national identities, are tightly linked to its language. What then to do (if anything) when the rise of American english and associated cultural detritus continues? English is the language of world business and of medicine and public health--though this might be argued by the francophile WHO/UN. There are clear efficiency benefits of a world language, i.e. english, but as accents fade will too the things that make a multicultural world so interesting?

Photo: Sydney opera house, taken July 2007 while attending the 4th International AIDS Society Conference.

Abstinence versus The Healthy Penis

The results of a US government sponsored study on abstinence-only education were recently revealed. The results may not surprise you--it doesn't appear to work. Abstinence-only policies have been a cornerstone of current domestic and foreign health-related programs, at significant financial cost. A funny and fascinating contrast to this failed health promotion strategy is the Healthy Penis campaign. This public health multimedia initiative has evidence to back up its successes and is quite a contrast to bland abstinence-only lectures.

Pur vida...

It is difficult to pick a single picture to capture the ecohaven country of Costa Rica. I was fortunate enough to spend some there in February. It is a fascinating country in many respects, even outside of its stunning natural wonders. In fact, its politics (democratic and peaceful), lack of standing army, and relatively prosperity only add to the delight of it beaches, cloud forests, and people. However, no paradise is immune from the 3 R's: real estate, "retirement", and riches, and the battle for the heart, soul, and property of Costa Rica is well underway.

Photo: The still active Volcan Arenal in Costa Rica, taken February 2007.

The Wire

What is the best show on television? The answer may surprise you, but some would say its The Wire on HBO. This Peabody winning show has been compared to Charles Dickens and praised as incandescent. And what would such a highly regarded show be about? Try the real Baltimore City, the complexity and simplicity of drug dealers, the flawed "honest" cop, and the repeated sorrows and humanity of poverty and inner city America that is played out in a riveting saga for your viewing pleasure and deeper reactions.

The Art in Our Lives

After spending a great deal of time and some money buying knickknacks and traveler's kitsch, I decided to largely stop and instead just buy local art. You can probably think of some explicit reasons why this may be a good thing: 1. Supports local artist. 2. Supports the arts. 3.Unique "souvenir".

Some may not think there is much room for art in RLSs. Few would argue that life essentials (food, water, shelter, security) should not be prioritized, but life moves dynamically and asynchronously. Picasso's quote after seeing the ~17,000 year old cave paintings of Lascaux, "We have invented nothing", is instructive, i.e. art is universal and ancient, and it can allow us a moment of higher reflection in the midst of the mundane and even tragic.

Photo: Painting by Sudanese artist, Abusharia Ahmed, currently residing in Kampala, Uganda.

Is This World Flat?

I have returned to Africa (and to blogging). Some light reading during my down time is The World is Flat by Thomas Friedman. This book makes an interesting argument that the world has been “flattened” through technology so that more individuals from around the world can take part in the global economy than ever. However, one of the fundamental requirements for flattening is the internet. As I try to blog from a continent with shamefully low bandwidth, it seems obvious that Africa has been left out of the flattening.

Attempts are being pursued to bring more bandwidth to Africa, but are still years away. So, most of the continent, while increasingly filled with connected individuals eager to be part of the internet age, is forced to crawl along at monotonous speeds.

The Living Space

But if we believe that architecture serves a society as well as reflects its values, then we must provide for those with the most need and the fewest options. -Sam Davis, UC Berkeley architect.

Why do poor people live in ugly houses? The answer to this question may seem rhetorical and sound condescending. But, Architecture, or should I say good architecture, may be defined as much by creativity, ingenuity, and empathy with the persons it is meant to live with, as with financial resources. Naivete aside (of course, many architectural masterpieces could not have been built without profuse funds), but the fundamental values of architecture would seem to be ones which could be adaptable to resource-limited environments.

Does it matter though? As it turns out, there is a fascinating relationship between housing and health which can be thought of holistically and spacially (do I live near a toxic dump?, do I live far away from jobs?, etc.) or down to the personal level of human interacting with designed space. An interesting take on this is a relatively recent increase in interest in designing health care facilities in ways to promote the healing process rather than make one feel deathly uncomfortable (a feeling doctors are not immune from).

What can I do?

A difficult question for anyone to answer, and perhaps also for someone to ask in the first place, is “What can I do?” Someone who answered that question quite well is my friend, William Harlan. He is editor-in-chief of Blue Ridge Outdoors and an ultramarathoner. Leveraging his skills, interests, and passions, he helped found www.runforafrica.org, a wonderful example of grass-roots connecting with high flyers connecting to the work on the ground. Check it out, sign up, get more fit in the process, and answer that challenging question posed above for yourself.

Conference Eve

It is the day before the official start of the XVI International AIDS Conference (IAC) in Toronto. The global health paradigm shifting Gates Foundation's eponymous leaders will help open the plenary. Celebrities will be circulating. And, political leaders cueing. One fact about the IAC that seems surreal but is quite true is that the IAC is no longer held in the United States (where it was founded) because of the US policy of denying visas to persons living with HIV/AIDS. This year's conference will be the largest ever, with an estimated 25,000 participants to attend.

Under the Nails

My new home is also a city on the bay. Baltimore is not an easy place. It takes caution, curiosity, and, occasionally, modest bravery to begin to understand and become more of a local in this challenging town. Baltimore has been captured in press by The Corner and on TV by Homicide. The most enduring image of the City to me, however, is the row house. In the newly gentrifying areas they are status symbols (positive ones); a few blocks away they are frightening and omnipresent reminders of an equality chasm.

San Francisco Streets

coffee house: a poem

the cups rest empty
but dreams will only wake to
her singular smile

San Francisco remains a conundrum. To some, it is a dream city, a resolution to a progressive, fantasy world which they may have idealized for many years. To others it is a modern day Sodom, as sanfranciscophobia demonstrates. It is the part of our country where iPods, the dot.com boom (and bust), google, and the United Nations were born. It is where the earth shakes with alarming regularity, a great bridge rests, and a stunning bay compliments the fog. My recent trip back to this city I lived in for four years reminded me of its fascinating mix of creativity, tolerance (for liberal-thinkers, that is), and natural and human-made beauty. Is it time to wake up already?

The Best Album of 2006

The Best (& Bravest) Album of 2006 may be the recently released "Taking the Long Way" by the Dixie Chicks. In 2003 just prior to the Iraq War, lead singer Natalie Maines said the following at a London concert,"Just so you know, we're ashamed the president of the United States is from Texas."

The response back home was immediate. Country music stations boycotted their music, former fans burned their CDs, death threats arrived, and Natalie eventually had to move from her native Texas. Country music has thrived on themes of patriotism, lonely soldiers, and American pride since 9/11. Some would say this has been done honestly and earnestly; some would say ideologically. The story of the Dixie Chicks is illustrative then of how one of country's own disagreed, was labelled a traitor, and now, has emerged defiant and stunning as the War continues and our President struggles.

Returning to the Garden

As may have been hinted at, I am back on US terra semi-firma. Peace Corps Volunteers (PCVs) have said that the hardest thing about their program is not the going or the staying, but the returning. Hard to compare my 3 months to their 2+ years, but I have an inkling of what they mean.

More specifically geographically, I am outside my hometown of Savannah, Georgia. Savannah has been called the most beautiful city in North America. It is also famed for being the star of the nonfiction book Midnight in the Garden of Good and Evil. It's history is long (for an American city) and its beauty, natural and designed, is unparalleled compared to any other city in the US (except perhaps for San Francisco). What does this have to do with Global Issues? Well, see the Bruce Feiler article from the NYT I blogged on from a while back for one type of answer.
Photo: The fountain in Forsyth Park, Savannah, Georgia. (Photo by Chris Jeffords).

The Making of a Better Person

Spending time in the poor countries of our world may make one a better person, but I am not sure it necessarily makes you a happier one. There are simply innumerable ways to lose varying levels of innocence here at a rapid rate (e.g. experiencing death, poverty, injustice, repression firsthand) which can lead to guilt, disillusionment, bewilderment, and, at the end of the pot-holed road, despair. Resilience then becomes such a vital characteristic to possess and grow in this land.

A strange counter to this weariness of wordly souls may be the following phenomena: It could be that it is the relativeness of poverty, not the absolute level, that determines a person's health and social outlook. Will then a middle-class non-black Westerner (called mzungu in Luganda) suddenly thrust into a position of relative wealth and power in Africa reap the physical and psychic benefits of an increase in social position? Or (as has been reported at some of the seedier bars of Africa) will this unearned status elevation lead to a life of gluttony and corruption with the requisite associated unhealthy behaviors? Case studies requested.

Big Pharma, Cynicism, and Truth

The 3rd International Film Festival of Uganda is ongoing in Kampala right now. I was fortunate enough to see The Constant Gardener this past weekend (for free!). A good movie about a corrupt pharmaceutical company (Big Pharma) running a dangerous drug trial on coerced Africans. Fiction, right? Can we just praise and dismiss this as an emotive, skilled, but ultimately cynical act of story-telling by a liberal, bleeding heart filmaker?

I actually hate conspiracy theories, but I'll be damned if I didn't read the following in the Washington Post the very next day: Pfizer faulted over drug trials in Nigeria. Pfizer happens to be the world's largest drug company if you're keeping track of such things. And, I'll be damned if I didn't meet a bunch of representatives from a contract-research organization (CRO) yesterday searching out sites in Africa for clinical trials of new tuberculosis drugs. It is almost enough to turn a pragmatic idealist into a paranoid cynic.

Photo: Kibera, an urban slum in Nairobi, Kenya where many scenes from The Constant Gardener took place. It is home to ~1 million persons living in rather depressing conditions. Taken 2001.

The Cultural Contradictions of International Research

Research in the developing world is quicksand, firewalls, and floods occasionally punctuated by light skies and cool winds. One thorny issue, suppressed to varying levels of depth in researchers' psyches, is the problem of ethics. Ethics not just in the sense of does Drug A's potential benefit outweigh its potential risk, but the foggier and subtler ethics involving cultural difference, the motivations, explicit and buried, of researchers and their collaborators, and the fundamental, overt power discrepancies between the North and the South.

Some folks talk of the 3 M's of global health: Missionaries, Mercenaries, and Misfits (a fourth M has also been proposed--Meddlers). Useful caricatures to a certain extent, but we certainly live in a more ambigious reality where many who work in RLS (resource-limited settings) have a mix of these characteristics--some of which may be in conflict. And the evolution/devolution from one M to another is a constant source of intrigue, talk, and concern.

Beeping as Metaphor

Throughout Africa, many people will call from one mobile phone to another and deliberately hang up before the call is answered . . . but just long enough to have call missed and a number/name appear. This phenomena is called "beeping" or "flashing".

Beeping itself is free. It usually can be interpreted as a request for the beeped to call the beeper back, thus placing the financial burden of the call on the person beeped (due to most mobiles in Africa being based on prepaid rather than monthly charges). However, beeping can also have more subtle meanings. While seemingly nonspecific, contextually it can send a very specific message such as "I am outside waiting" or "'Thinking of you."

It can be remarkable what is able to be conveyed when you are forced to keep it simple--A ring tone can proxy for freedom of speech, a text message can rally a protest, and a beep can start an affair. It is said that necessity is the mother of invention, but human curiosity and finding new ways to flirt certainly help to move things along. . .

What's God got to do with it?

Just as you can not ignore culture and ethnicity when confronting AIDS in Africa, it would be a mistake to dismiss the role of religion. Religion permeates so much in this arena, from missionary hospitals to PEPFAR policies to patient and provider beliefs and behavior.

Religion does not necessarily need to be a divisive force. A friend of mine, Jennifer Gross, worked at a Christian faith-founded hospital while in the Peace Corps though she was not Christian. And I happen to work with a Catholic faith-based organization, Reach Out Mbuya, while not being Catholic.

Photo: The motto for Kiwoko Hospital where Ms. Gross worked. A hospital in the middle of nowhere originally founded by missionaries. Interesting fact: Hospital has baby incubators run off solar power. Taken February 2005.

Modern Medicine Man

Chance, African spirits, or some other force crossed my paths with an American psychologist, Jamie Fish, who is working with and studying traditional healers in Uganda. Ms. Fish invited me, quite literally, into the forest to teach and learn with these healers. Curious, I did so and spent an enlightening time participant-observing their classes and reciprocated by answering their questions about HIV/AIDS.

Traditional healers significantly outnumber medical doctors in Uganda--a common phenomena in much of the developing world. To many, they are the frontline health care worker. How then do we incorporate them (or they incorporate us) into the care of the sick?

A pragmatic stance would be "Use what works." The rub with traditional medicine has long been proving it works. But the scientific method and traditional medicine need not be in opposition and, in fact, can be quite, ahem, complimentary. For example, the US has the National Center for Complementary and Alternative Medicine which uses scientific rigour to evaluate these types of therapies. And, one of the current best treatments for malaria, Artemesinin, is derived from a Chinese plant used by traditional healers for centuries.
Photo: Botany class at PROMETRA Traditional Medicine Training, Research, Treatment, and Demonstration Centre, Buyijja, Uganda, March 2006.

Why Did I Die?

One of our patients died yesterday. She did not die of AIDS or from a side effect of the HIV medicines she was taking. Instead, this is a young woman who had become pregnant with a child she did not want. She tried to self-abort her pregnancy (abortions are illegal in Uganda) and something went horribly wrong. She collapsed and died on her way to a local hospital.

This is not meant to be a pro-choice post. Or pro-women even. But to ask again the question as to how a person comes to such a place and end. And, of course, what can be done about it? The modest goods which might come from this sadness is to think more deeply about the context in which health care (HIV care in this case) must exist in to thrive, rather than to be so brutally and wastefully stunted.