Norway v. Somalia, theatre v. food

“Why do we care about 70 dead people in Norway when we have 10,000 starving in Somalia?”

This question has not once failed to absolutely infuriate me every single time I’ve heard it over the past few days. Constantly preceded by a professed desire to avoid preaching, this is an intellectually lazy and  embarrassingly awful way to highlight a crisis and I’m ashamed of the people who resort to using it. Tragedy in cold blood is not something you invoke to highlight your pet issue. Here, for the record, are some good reasons we should care:

  • The anti-Muslim sentiment professed by the attacker is directly tied to overwhelming rates of immigration from North and East Africa – which, of course, largely result from things like poor farming conditions and famines and greater social unrest than is present in Europe.
  • We typically know how to deal with people who plant bombs in industrialized nations; we still haven’t figured out how to tackle desperate hunger. This is not a question of allocating resources other than media attention. You can still tinker with the treatment regiment for the cancer patient while extracting a bullet from another.

On a less volatile note, this is my youtube video of the week (I clearly miss doing the announcements): a very snarky commentary on where to throw your extra cash.

Norway v. Somalia, theatre v. food

Shots in the Dark

When it comes to a Sophie’s Choice sort of prioritizing, I tend to value national security over minor setbacks in other fields. This is not a popular sentiment in the field of public health, where evangelists are evangelists and the US government is a happy target frequently accused of, god forbid, acting on its own interests. In terms of bulk cost calculations – why spend billions on aircraft carriers when that same money could go to treating malaria? – I also think that Givewell types tend to undervalue hegemonic stability and underestimate, or have perhaps forgotten, the dangerous down stream flailings of a wounded giant. I am One of Those Democrats, and I’m not sorry for it.

But foreign aid, and particularly well-designed health assistance, is in the interest of national security. Unrest results from lack of satisfaction with the state of affairs; extreme dissent emerges in hungry, impoverished, and desperately ill populations where people have the balls to get angry (that is to say, in a less crude manner, societies where women possess limited rights – but that’s another post). And here are a few True Things:
1. Maintaining public health programs abroad is a critical part of the ability of the United States to influence policy abroad in a subtle, effective, and generous way.
2. Vaccination is unparalleled as far as things in our toolbox go. They save money – something entirely uncommon in international aid. This may sound very simple, but it’s extraordinary: a successful vaccination program allows us to prevent lengthy courses of treatment for expensive diseases in difficult-to-access areas.
3. The vaccination “scandals” in the US – such as Andrew Wakefield’s ridiculous shenanigans – have resulted in an inexplicable amount of damage. Accusations of vaccines causing autism in a nation where most people are literate, where 70% graduate from high school after completing a basic biology courses, have been crippling: as an example, one of the most conservative governors in the nation was bullied into not mandating a Gardasil vaccine. The amount of damage associated with something most people don’t understand is amplified as the education of the general population plummets. So when a rumor starts up that US vaccines are intended to render Muslim children infertile in Nigeria? People believe it, and consequently have their children die from preventable diseases.

In attempting to use DNA samples obtained from needles to confirm Osama Bin Laden’s presence in the compound, we did not give the Pakistani children in Abottabad the full 3 courses of the hepatitis B vaccine necessary to ensure functionality. Those kids are not going to have access to the full course – and if they do, why should they trust it?! Why on earth should they, when a legitimate ruse has been constructed against them in which vaccination was hardly considered a fringe benefit? I don’t see what this should have to do with the political sympathies of the children involved, or of their parents; when the United States lies abroad, when we conduct ineffective schemes in places where our word is already compromised, we make enemies. When we do a good thing poorly, we make enemies. Let’s stop doing that right now.

Shots in the Dark

South by…

This is a bit behind the times, but as of late June Texas was one vote away from approving a Confederate flag license plate. Here’s a bit from Paul Burka at Texas Monthly that I’m going to quote directly simply because I agree with the sentiment wholeheartedly:

Texas is both a southern and a western state, and, of the two, I much prefer the western heritage to the southern. To me, the Confederate flag is inextricably linked with a dark part of our history, namely, segregation. That is my personal reaction; I do not ascribe that view to others. I had a history professor who liked to say, “Every man his own historian,” by which he meant that each must make our individual judgments about history.
The west, on the other hand, is a land of great vistas and rugged landscapes and endless distances that reinforce our state’s great myths of the wide open spaces and the great ranches and oil fields that sat atop land so unforgiving that only the devil could love it.

Celebration of the Confederacy is something I don’t understand in general. I get the bit about heritage, and about preserving family histories in particular; I also understand how that aspect of the trend appeals so strongly to the collection of southern fratboys who have adopted it. What I don’t understand how Texas, of all places, fits in. We are a state as focused on progress and expansion as we are dedicated to pride in the past, but that pride itself is focused and nuanced, and particularly self-centered. I will take annual joy in breaking from Mexico, in forging a new nation and succeeding – and also in the eventual recognition that that nation could become something better and stronger by joining with another. I will never comprehend exit en-masse in support of a bloc we did not rely upon quite so heavily, and can’t begin to suspend recognition of social injustice for the sake of a cultural symbol. Among other things, it also clashes quite violently with my mental categorization of what I consider home. Even Houston, overrun with immigrants of all stripes and suburban sprawl and Czech barbecue – almost especially Houston, entrenched in oil money – is, in my mind, very much a part of the American Southwest. “Rugged” is the overused, romanticized, and appropriate term. In Blood Meridian, Cormac McCarthy begins a sprawling border epic with a crawl out of the gulf and through Nacogdoches. In Padre and Palacios, we ride horses on the banks. Our old money eschews pastels and boat shoes for pressed Levi’s and hand-crafted boots. I like all of these things this way, very much, and association with the south rather than the west in such a deeply embarrassing way seems incongruous. Let Georgia pull shit like this; it doesn’t belong here.

All that being said, I’m desperately hoping it gets approved, if only because it’s the sort of story that would get national recognition: any ammunition allowing Obama to take down Perry more easily is a good thing.

South by…

Student Design Projects

I know people who are approaching BIOE 451/452 with the goal of walking out of the Sallyport with a degree in one hand and a patent application in the other. They are, however, vastly outnumbered by those who a) want to attend medical school/some other grad program, b) don’t care enough/wont’t create something good/will burn out or c) don’t know how money/patents work (I go here, and that’s hopefully). But a lot of the projects I’ve seen in previous years are good, and the global health projects in particular have a lot of potential for use at very low development costs (there is NO source of free labor like a graduating senior who wants an A in their capstone course). Here’s the thought process:
– Many engineering schools around the world feature degree programs culminating in design projects, in which the final product is a functional, marketable device.
– Many of these projects focus on global health; for example, bioengineering students at Rice have constructed low-cost automated syringe pumps appropriate for clinics lacking in staff, and cell phone cameras adapters for diagnosis of neonatal jaundice.
– Many students who spend their senior year working on such projects abandon them.

And here are some potential fixes:
– Financial support for students who want to make their class things into real things. USAID is trying to start making small-level grants workable, but it’s not there yet, and a student initiative of this sort would be the perfect place for them to begin.
– DESIGN PROJECT DATABASE. This would allow students from different universities interested in continuing work to interact with one another, rather than the pre-med they got paired with. This year alone I know Rice, Columbia, and Northwestern all had projects developing low-cost autoclaves: a PERFECT scenario where something like this could be useful for both exchange of ideas and potential future investment. A project like this would have to be university-led, as in design teams would need to be urged by a professor to actually submit occasional project updates throughout the year (which wouldn’t be hard for anyone doing regular documentation) (potential lead rice envision grant project, hmmmmmmaybe).

Student Design Projects

At the intersection of public health and national defense: DoD labs

There’s a new CSIS report out on the effectiveness of overseas labs functioning under the Department of Defense. General findings include more-frequent than expected interaction with regional offices, and an unexpected focus on diseases relevant to the endemic population. This is natural, if you think about it: DoD labs function at the interest of the US military, and members of the service on the ground are (ignoring the effects of malnutrition and resistance) just as susceptible to malaria or cryptosporidiosis or what have you as anyone in the area as a function of birth. The primary goal of these infectious disease units is, consequently, to protect first-world soldiers from third-world diseases.

These labs are important for a few reasons:
– Proximity to location of interest. A permanently funded station abroad to conduct research is an invaluable resource, and allows for longer-term projects.
– Funding is through the defense department rather than general research grants. Though intradepartmental funding is free to shift from year to year, this session of Congress (as with many other sessions of congress) has demonstrated greater reluctance to cut defense budgets than allocated funds for medical research.
– Staffed by military personnel rather than civilian researchers, they stand at the interface of aid and security, and are fit to work with the intricate relationship between the two. More on that sometime later.

This got me thinking:
Health technologies for combat situations in the US are identical in need to those abroad: point-of-care diagnosis is critical in a high-speed situation, no freeze chain may be available, and disposable or reusable technologies may save lives. This represents an alternate path to funding : develop appropriate technologies for and through the US military, cut costs subsequently to re-appropriate technologies for use in resource-poor environments. Implement through existing labs that have established relationships with locals in disease-ridden locations, and with flexible personnel available to monitor program effectiveness.

And put it under “defense funding.”

Why? Because there is no greater source of goodwill than saving lives at the community level. I’m beginning to firmly believe that one of the most firmly IGNORED issues is health in the backwaters(mountains?) of the Middle East. The region lacks instant recognition, the celebrity appeal of sub-saharan Africa, and is of course known for a plethora of other problems. But the concerns, particularly in overall security, are MUCH more high-risk (if less high-profile) with regard to US interests – and where terrorist organizations recruit out of poverty and desperation as a result of illness, where women in childbirth are occasionally not taken to a hospital to be given a caesarian by a man, where operations may be postponed until a family can pay, there can be fewer more substantial security investments.

At the intersection of public health and national defense: DoD labs