Amman: Round Two

I’m headed back to Jordan this summer for thesis research, fieldwork, and (of course) weekend canyoneering. The original plan was Beirut – still angling to make it back & forth a few times. Here are a few things I’m going to work on while gallivanting about the Levant. All advice, criticism, and insight is more than welcome!

1. Gather some hard data on how immunization rates change during Ramadan.

I’ve been tracking patients that miss their immunizations for about seven months now. We started *just* before Ramadan last year, and noticed a pretty substantial increase in the number of missed appointments during that time. This is probably not surprising to anyone, but it’s also completely unstudied. Delaying immunization by a week or two isn’t a huge problem in an area with decent herd immunity, but waiting a full month before maybe forgetting about it, when migrants and streaming in and out from a warzone where hospitals are being bombed, when polio strains are blooming across the border, when we’ve seen unprecedented outbreaks of infectious disease along Syria’s border with Turkey? That’s not a good idea.

My hunch is that general fatigue and a mismatch between maternal waking hours and clinic hours might be the major inhibitors, but I’m open to other ideas (someone just told me some people view vaccination as breaking fast). No moms want to wait in line for hours in the early morning after preparing food all night. Nobody wants to do anything at 3 p.m. after nine hours without food or water. I barely drag myself to 8 am classes on normal days and definitely cannot without scary volumes of espresso, so I feel like these things aren’t unreasonable. One specific goal is to channel these findings into specific policy recommendations on clinic hours, which could be a good work-around.

2. Expand UNRWA’s mobile health capacity. We’ll be issuing immunization prompts to more clinics – hopefully some outside of Jordan, and some catering to Palestinian-Syrian double-refugees! – and gathering some hard data on effectiveness and patient satisfaction. Beyond that? The specifics are still up in the air. One promising suggestion from last summer involved sending reminders on basic aspects of diabetes management to adult patients. I’m not a huge fan of basic mobile health initiatives like this (engineers are technology snobs), but I do think they can be especially useful for patients with limited mobility. Gaza New Camp, in Jerash, provides a good (well, awful) example. The ’67 refugees who live in the camp were not afforded Jordanian citizenship, so they can’t obtain licenses or buy cars; if they bought motorcycles instead, however, they’d be short-changing the Jordanian economy by investing in a cheaper mode of transportation, so they’re also not allowed to buy motorcycles (cue eyeroll). So, if you live there, and your diabetes symptoms progress beyond anything you can manage, good luck getting to your regular dialysis treatments.

Of course, it’s not a problem if for Jordanians who reside in Abdoun mansions – take either of your Porsches down to King Hussein. But that kind of extreme disparity is what allows global health issues in the Middle East to fly under the radar: everything averages out to Middle Income Yellow (new Crayola shade?) and funding is directed elsewhere. Bigger rant on this later.

3. Health care as a bargaining chip. This is an iffy one, perhaps best illustrated by Hezbollah. They provide medical care that drastically undercuts the going rate on Lebanon’s private market, and care is FREE for Hezbollah party members. If you’re poor and sick and on the fence, is that opportunity enough to sway your political stance? There’s rumor of similar models being tested by different extremist groups in Mali, and I’m worried that this might be a growing phenomenon as AQIM spreads southward throughout and across the Sahel to sicker and more impoverished lands.

To be fair, one could argue that USAID does the same thing, “From the American People” emblems and all – maybe that would make a nice proxy study. I’m not sure exactly of how to pursue this line of investigation, but I think it’s really important and I’m surprised it isn’t getting more attention. Tentatively, I’d like to head up to Zaatari, where UNRWA is trying to deal with lots of pharmaceutical theft & redistribution, to see if there are any grander motivations aside from making a buck on the UN’s dime. Maybe I’ll gather up the gumption for more casual interviews in Beirut. More broadly, if there is any real political shift that comes from this discounted care, I’d like to see it incorporated as a very low-cost national security strategy. The US is good at fighting fire with bigger fires, but fighting knockoff pharmaceuticals and pandering with effective, strategic, and heartfelt health investments seems like a much better deal to me.

Amman: Round Two

What I’ve Been Reading

Winter break was created to allow time to delve deep into fiction and irrelevant nonfiction, I’m certain of it. I’m also terribly lazy and not quite done with all of them, but here are the best of the books that have been lingering on the nightstand as of late:

1. Wind, Sand, and Stars by Antoine De Saint-Exupery [nf]. Saint-Exupery is best known for Le Petit Prince; while not writing children’s stories, he jetted about the globe delivering mail for Aéropostale and compiled some achingly beautiful memoirs that use flight as a vehicle to clarify his thoughts on risk and tenacity and meaning. This is my favorite book ever, probably, and a re-read.

2. What it Takes by Richard Ben Cramer [nf]. This is the rightfully-famed trail of the 1988 presidential race – as noted in the intro, it seeks to figure out what on earth “kind of life would lead a man to think he ought to be president” – and is easily the most engaging thing on this list. Recommended for Houstonians in particular, if only for the Bush/Baker bits, River Oaks jokes, and IH-45 traffic complaints that pop up while following HW. Bonus description of Joe Biden: “There was (to be perfectly blunt, as Joe would say) a breathtaking element of balls.” That should be all you need.

3. The Son by Philipp Meyer [f]. Texas by generation. This got a tremendous amount of press as the “next Lonesome Dove” which I don’t agree with (Lonesome Dove is grand and aspirational; this is grand and gritty). Maybe it’s what would happen if Cormac McCarthy and Larry McMurtry edited each other while drinking lots of whiskey.

4. The Better Angels of Our Nature by Steven Pinker [nf]. Chronicles a decline in violence and rise in civility throughout the ages, with a hearty dose of evolutionary psychology. Impressively well-documented for all its breadth. Gladwell gets all the credit for popular writing about complicated subjects, but I really think Steven Pinker manages to achieve the same engaging accessibility without nearly as much kitschy oversimplification (I just realized I’ve been reading his stuff for [gasp/cringe] nearly ten years). If you’ve talked to me about nearly any international conflict over the past six months or so I’ve probably mentioned something from this book; it’s just wonderfully applicable.

5. Ada, or Ardor by Vladimir Nabokov [f]. More of Nabokov injecting his delightful synesthesia into off-kilter and verboten love stories. Still in the middle of it, but I like this quite a bit better than Lolita, in particular for how the structure of the novel manages to toy with time and memory.

What I’ve Been Reading