health


Historian Laurent Dubois … “Anyone who lives in a democratic society in which race doesn’t equal a denial of rights has some debt to the Haitian revolution,” he reflected in an interview. “The very notion of democracy that we consider commonsense emerged because of that revolution. If that’s something we cherish then we owe that to Haiti, which has suffered more for its victory rather than been rewarded for it.” 
from the Boston Globe in 2004

People gather outside a damaged MSF office in Port-au-Prince to receive help after a 7-magnitude earthquake hit the capital city on January 12.

It would be nice to give something back to Haiti, especially when help is so urgently needed.  A friend in the medical profession sent me this appeal. I made a contribution and I recommend the opportunity to your attention. As my friend said:  This is a great organization, please consider it if you are planning to donate to help.   

Haiti: MSF Teams Set up Clinics to Treat Injured After Facilities Are Damaged

Donate here to support MSF’s work in Haiti.

The first reports are now emerging from Doctors Without Borders/Médecins Sans Frontières (MSF) teams who were already working on medical projects Haiti. They are treating hundreds of people injured in the quake and have been setting up clinics in tents to replace their own damaged medical facilities.

The Martissant health center in a poor area of Port-au-Prince had to be evacuated after the earthquake because it was damaged and unstable. The patients are now in tents in the grounds and the medical staff have been dealing with a flow of casualties from the town. They have already treated between 300 and 350 people, mainly for trauma injuries and fractures. Among them are 50 people suffering from burns—some of them severe—many of them caused by domestic gas containers exploding in collapsing buidings. At the Pacot rehabilitation center another 300 to 400 people have been treated. In one of MSF’s adminstrative offices in Petionville, another part of Port-au-Prince, a tent clinic there has seen at least 200 injured people. More are getting assistance at what was the Solidarite maternity hospital, which was seriously damaged.

One of MSF’s senior staff, Stefano Zannini, was out for most of the night, trying to assess the needs in the city and looking at the state of the medical facilities. “The situation is chaotic,” he said. “I visited five medical centers, including a major hospital, and most of them were not functioning. Many are damaged and I saw a distressing number of dead bodies. Some parts of the city are without electricity and people have gathered outside, lighting fires in the street and trying to help and comfort each other. When they saw that I was from MSF they were asking for help, particularly to treat their wounded. There was strong solidarity among people in the streets.”

Another MSF coordinator there, Hans van Dillen, confirmed that Port-au-Prince was quite unable to cope with the scale of the disaster. “There are hunderds of thousands of people who are sleeping in the streets because they are homeless,” said van Dillen. “We see open fractures, head injuries. The problem is that we can not forward people to proper surgery at this stage.”

So many of the city’s medical facilities have been damaged, healthcare is severely disrupted at precisely the moment when medical needs are high.

MSF is also working to get more staff into the country. Around 70 more staff are expected to arrive in the coming days. MSF is sending out a 100-bed hospital with an inflatable surgical unit, consisting of two operating theaters and seven hospitalization tents. Nephrologists will be sent as part of the team in order to deal with the affects of crush injuries. However, transport links are difficult and it is not yet clear whether supplies and medical staff will have to go in through neighboring Dominican Republic.

MSF is also concerned about the safety of some of its own staff. There are 800 of them and not all have yet been accounted for because of the poor communications and general disruption.

Donate here to support MSF’s work in Haiti.

____________________

Added January 14

Oxfam International has an ongoing presence in Haiti, and are working with the critical issues of water and shelter.

Donate here to support Oxfam

Our immediate priorities will be providing safe water and shelter material for the people who have lost their homes.”
Cedric Perus
Oxfam’s humanitarian coordinator in Port au Prince
January 14, 2010

A six-strong team of Oxfam emergency specialists has been dispatched to Haiti from the UK today to bolster the charity’s response to the devastation wrought by the earthquake that struck the country on Tuesday.

Cedric Perus, Oxfam’s humanitarian coordinator in Port au Prince said:

“I have seen wounded people flooding into the hospitals and buildings of several stories high that are now totally flat. Several thousands have probably died in the quake, but it will it will take time to get a full picture. Bodies may stay under the rubble for a long time because it is difficult to access some sites and heavy lifting equipment is in limited supply.

“There are bodies all over the city. People have nowhere to put them so they wrap them in sheets and cardboards in the hope that the authorities will pick them. People have also piled bodies in front of the city’s main hospitals.

“Oxfam’s teams have now started to assess the scale of the disaster across the different parts of Port au Prince as some have been more severely affected than others. The epicenter was near the slum of Carrefour, where people were living in flimsy shacks. There are reports that over 90% of its buildings are in ruins.

Our immediate priorities will be providing safe water and shelter material for the people who have lost their homes. Many people have lost their homes and were sleeping out in the open last night. There has been no rain yet, but there was rain earlier in the week and if it comes again it will make the situation much worse for all those made homeless by this quake. It is dangerous at night. Lootings were widespread and some markets were ransacked.”

Oxfam is preparing to send stocks from its Bicester Warehouse in Oxfordshire, UK. Materials that will be sent include plastic sheeting and equipment for water distribution, purification and storage.

Communication has been difficult since the 7.0 on the Richter scale quake struck 10 miles southwest of Haiti’s capital, Port-au-Prince, but the situation is undoubtedly grave. Homes, office buildings, roads, schools, hospitals and hotels have collapsed. Millions of people are affected and the aid agencies need millions of dollars to get aid to all the people that need it.

Donate to the Haiti Earthquake Response Fund

Please consider helping fund our Haiti Earthquake Response Fund. These Oxfam affiliates are running direct appeals:

Up to 13 million barrels of oil have spilled in the Niger Delta ecosystem over the past 50 years, representing about 50 times the estimated volume spilled in the Exxon Valdez disaster in Alaska in 1989. Niger Delta Natural Resource Damage Assessment and Restoration Project, PDF.

Oil spill in the village of Ikarama, Bayelsa State, Nigeria, 7 February 2008  © Kadir van Lohuizen/NOOR

Oil spill in the village of Ikarama, Bayelsa State, Nigeria, 7 February 2008 © Kadir van Lohuizen/NOOR

These spills equal the amount of 1 Exxon Valdez sized oil spill per year. And this is taking place in one of the most sensitive wetlands of our planet, part of the lungs of the planet. The spills pollute the land, pollute the water, clog the creeks, and gas flaring pollutes the air and the rainwater, bringing down toxic acid rain on land and water and all that live there.

As one Niger Delta fisherman stated:

If you want to go fishing, you have to paddle for about four hours through several rivers before you can get to where you can catch fish and the spill is lesser … some of the fishes we catch, when you open the stomach, it smells of crude oil.

The Niger Delta is one of the 10 most important wetland and coastal marine ecosystems in the world and is home to some 31 million people. The Niger Delta is also the location of massive oil deposits.

Under Nigerian law, local communities have no legal rights to oil and gas reserves in their territory.

This report focuses on one dimension of the crisis: the impact of pollution and environmental damage caused by the oil industry on the human rights of the people living in the oil producing areas of Niger Delta.

This report is a report from Amnesty International Nigeria: Petroleum, Pollution and Poverty in the Niger Delta – Report PDF. The report was released June 30, 2009.

The main human rights issues raised in this report are:

  • Violations of the right to an adequate standard of living, including the right to food – as a consequence of the impact of oil-related pollution and environmental damage on agriculture and fisheries, which are the main sources of food for many people in the Niger Delta.
  • Violations of the right to gain a living through work – also as a consequence of widespread damage to agriculture and fisheries, because these are also the main sources of livelihood for many people in the Niger Delta.
  • Violations of the right to water – which occur when oil spills and waste materials pollute water used for drinking and other domestic purposes.
  • Violations of the right to health – which arise from failure to secure the underlying determinants of health, including a healthy environment, and failure to enforce laws to protect the environment and prevent pollution.
  • The absence of any adequate monitoring of the human impacts of oil-related pollution – despite the fact that the oil industry in the Niger Delta is operating in a relatively densely populated area characterized by high levels of poverty and vulnerability.
  • Failure to provide affected communities with adequate information or ensure consultation on the impacts of oil operations on their human rights.
  • Failure to ensure access to effective remedy for people whose human rights have been violated.

The report also examines who is responsible for this situation in a context where multinational oil companies have been operating for decades. It highlights how companies can take advantage of the weak regulatory systems that characterize many poor countries, which frequently results in the poorest people being the most vulnerable to exploitation by corporate actors. The people of the Niger Delta have seen their human rights undermined by oil companies that their government cannot or will not hold to account. They have been systematically denied access to information about how oil exploration and production will affect them, and are repeatedly denied access to justice. The Niger Delta provides a stark case study of the lack of accountability of a government to its people, and of multinational companies’ almost total lack of accountability when it comes to the impact of their operations on human rights.

More oil is being prospected and discovered throughout Africa. Rather than an outdated holdover from an ugly past, Shell’s pollution of the Niger Delta is probably the model for oil exploitation across the African continent. Only if African countries stand up for themselves and their people, can the devastating effects be mitigated. Far too many governments in Africa are not accountable, or only barely accountable to their people. And even where there is a will, the outside powers and donor countries will not make it easy. Look at what is happening in Somalia, another potential source of oil. The international donor countries are keeping it destabilized in the name of fighting “terrorism”. When Somalia did develop its own government in 2006, it was rapidly crushed by the US using Ethiopia as a proxy. This is what is known as stability operations.

In response to a question, I was talking to someone in the neighborhood where I work about pollution and oil exploitation in the Niger Delta. He was not really interested and brushed it off, saying, “we have to get our oil from somewhere.” This is someone with whom I’ve had a number of friendly conversations, and generally think of as a nice guy. I think his response typifies the attitude of people in the US, and in the developed and rapidly developing world.

Just as the European colonial powers spoke of bringing Africa the 3 Cs, Christianity, Civilization and Commerce, the US, and the US Africa Command speak with straight faces of bringing Africa the 3 Ds, Defense, Diplomacy, and Development. It was a mirage the first time, and this is pretty much the same thing, minus Christianity. It is not done to benefit the people of Africa but to fool them. It is like the distraction of a magician, so you don’t see how he does the trick.

As Dr. Wafula Okumu testified:

To paraphrase Kenyatta’s allegory, “when the Whiteman came to Africa, he was holding a Bible in one hand and asked us to close our eyes and pray. When we opened our eyes after the prayer, his other hand was holding a gun and all our land was gone!” Africa’s colonial history was characterised by military occupations, exploitation of its natural resources and suppression of its people. After testing decades of independence, these countries are now jealously guarding their sovereignty and are highly suspicious of foreigners, even those with good intentions.

There are many professed good intentions, and very few genuine good intentions among the powers gathering around for this latest scramble for Africa, particularly in the search for oil. It behooves Africans to be very wary indeed.

Hero Rat sniffing a landmine

Hero Rat sniffing a landmine

From Afrigadget comes the story of:

“Scratch and sniff” Africas HeroRATS

I heard about this extraordinary use of rats years ago and am hoping that sharing it today will bring a smile to many faces. Although Mozambique’s civil war ended nearly two decades ago, unexploded ordinance continues to be a major cause of injury and death. But now they have a solution. Rats! Local giant rats are being trained and employed to assist in mine detection.

Rats have the amazing record of being able to detect mines 95% of the time. If only all our politicians would work this hard and for a banana….. I keep hoping against hope…

For more scientific information, read this article in the Journal of Mine Action

HeroRat videos on YouTube:

APOPO (5:55)
(links corrected 3/22)

You can adopt a rat at the HeroRat.org website for 5€ per month.

Adopt a HeroRAT

HeroRats not only detect landmines, they also detect tuberculosis in sputum samples. When demining:

A trained HeroRAT can clear 100 m2 in 30 minutes, equivalent to two days work for a manual deminer.

In detecting tuberculosis:

… in 7 minutes one rat can evaluate 40 samples which is the equivalent of 2 days of microscopy work for a lab technician.

Plus, the rats are too light to explode landmines, they don’t mind repetitive tasks, and because, although they are large rats, they are small animals, they are easy to house and move around, and inexpensive to feed. The program provides work for farmers and restores land for farming.

I think supporting this program is an excellent idea for anyone. It is also nice because it is something that can be shared with children. But it would be even better to see some government security dollars spent on an inexpensive program that actually makes people a lot more secure.

Oil spill fouls the water supply

Oil spill fouls the water supply

defenders of human rights

defenders of human rights

Violence has been an instrument of governance in the Niger Delta as a constant companion to the oil business. Sokari Ekine has written a moving and well documented account of “how women have spearheaded the defence of local livelihoods through organised protests which cut across regional ethnic divisions” in Women’s responses to state violence in the Niger Delta, Violence as an instrument of governance.

The Niger Delta is a region of Nigeria that has been subjected to excessive militarisation for the past 13 years, where violence is used as an instrument of governance to force the people into total submission (Okonta and Douglas, 2001; Na’Allah, 1998). It is where, by far, the majority of the people live in abject poverty and where women are the poorest of the poor (Human Rights Watch, 2002; 2004; 2007). This region has little or no development, no electricity, no water, no communications, no health facilities, little and poor education. In contrast, the region generated an estimated over US$30 billion in oil revenues over a 38-year period in the form of rents for the government and profit for the multinational oil companies

Now, in order to keep this population poor, without water, without communications, or health facilities, or education, or jobs, in order to keep oil and money coming out of the Delta, going to the politicians and the oil companies, according to Nigeria’s Next, The Mercenaries Take Over.
(h/t Foreign Policy Exchange)

The Niger Delta is crawling with British and American private paramilitary companies providing security services for clients in the oil and gas industry, in clear violation of Nigerian law

There are at least 10 mercenary companies operating in the Delta, including Triple Canopy, Control Risk, Erinys International, ArmorGroup, Aegis Defence System, and Northbridge Service Group, the successor company to the now defunct Executive Outcomes … “the notorious South African paramilitary force known for its role in helping the Angolan government during the war with the rebel UNITA forces of Jonas Savimbi,and for fighting directly in the Sierra Leonean civil war.

Our laws forbid foreigners from operating armed security companies or paramilitary organisations of any kind and, strictly speaking, these hired guns are forbidden from freelancing here. But almost all of them have sought to get around the law by forming vague partnerships with local companies and by claiming to provide mainly advisory services, which contradict their stated objectives and services on their parent websites and their known activities in other countries.

Government denial

Astonishingly, our military and security services also claim to know nothing of their presence.

“I am not aware,” said the spokesman for Defence Headquarters in Abuja, Col. Christopher Jemitola. “If there is any evidence, including photographs, bring them up and we will address the issue.”

Some of the security companies also claim not to bear any arms in the Delta, a chaotic frontier where foreigners are routinely kidnaped and gunfights are a fact of daily life in cities such as Port Harcourt and in the creeks of the mangrove swamp.

This denial beggars belief, said Ishola Williams, a former commandant of the Nigerian Army Training and Doctrine Command.“They must be magicians,” said the retired general. “Are they going to fight the militants with karate or judo? We have to be very realistic, because if someone gives you a contract to provide protection for oil workers in the Niger Delta, what would you do– you would go there with your bare arms?”

Apart from the Biafran war of 1967-70, paramilitary groups are relatively new to Nigeria. But the protracted and deteriorating insurgency in the Niger Delta has made them increasingly sought after. One of the security companies that claims local partnership in Nigeria is Erinys International, a British company with experience of guarding oil installations in Iraq.

In the wild frontier of the internet, private military companies are rife and active, peddling their services to prospective patrons. Many of them have announced that they are now operationally domiciled in Nigeria’s Niger Delta, and some claim they work in partnership with the military Joint Task Force, the Nigeria defence forces known by its acronym JTF and which has primary responsibility for security in the area.

A JTF spokesman, Musa Sagir, denied knowledge of the existence of the foreigners nor any collaboration with them. We don’t have any connection with any foreign military contractor,” Col. Sagir said, adding that “With my inside knowledge and experience in the Niger Delta, in particular River State, I don’t have formal or informal knowledge of the existence of foreign military contractors.”

What was more, he added, somewhat indignantly, “we are trained for the job and we know what to do at the right time.”

Willaims, the retired general and now head of the local Transparency International office in Nigeria, was buying none of that. “Remember that these are government officials. If they say they know them, you as the press will go and blow it up that foreign military companies have taken over the job of security in this country and what are they doing? The House of Representatives will take it up and want to investigate, and it shows the weaknesses of all the armed forces and all the security agencies in Nigeria.”

Official denials and a seeming lack of awareness of the activities of these companies also demonstrate the enfeebled state of the Nigerian state, said Kayode Soremekun, a professor of international relations at the University of Lagos.

My own problem here is that the ministry of internal affairs and ministry of defence are not aware of their existence,” Soremekun said. “It is either one or two things: the ministry of defence is genuinely ignorant of this particular development, or it is pretending. Either way it does not bode well for the Nigerian state. And it simply shows what a lot of people had thought all along, that those who really control the Nigerian state, those who really determine what happens in the Nigerian state, cannot even be located in this country. You can locate them offshore.”

Since our laws do not allow for foreign owned security company to operate locally, most of these private security contractors have resorted to calling themselves “risk management consultants” rather than hired guns.

This way, they are able to provide a cocktail of services and products that are not different from what regular private military companies provide– or what the same companies do elsewhere in countries like Sierra Leone

Most of the companies are not forthcoming about their activities, for example:

At Control Risk, yet another of these security companies active in the Niger Delta, company spokesman, Edward Murray, told Next on Sunday to “go to hell” when asked to help define the scope of their Nigerian operations.

The company states that it is in Nigeria to protect British oil workers and names “a large oil producer” as a client. However, its mission includes, according to its official web site, “the provision of technical security services (onshore and offshore) and sophisticated management of security strategy in places where security is linked to broader issues of social performance.” In plain English, the company guards oil company interests against restive locals.

The mercenary companies are there to protect the “rights” of the oil companies to kill and oppress the people of the Niger Delta, pollute their land and water, and steal the resources from under their feet.

The people who are suffering most are the women. They are also organizing and fighting back. So women and children will remain major targets of violent military governance.

Meredeth Turshen wrote in 2004:

Specific effects of oil development on women’s health seem not to have been investigated. Although I found an article on the effects of exposure of crocodiles to sub-lethal concentrations of petroleum waste drilling fluid in the Niger Delta basin, I could find nothing on the health of women who live near oil wells and oil production stations, and nothing on reproductive outcomes in areas adjacent to petrochemical plants. Yet it is known that cadmium, chromium, mercury, and lead are contained in the refinery effluents that are constantly discharged into nearby bodies of water. At high concentrations these metals cause metabolic malfunctions in human beings. They enter the food chain through the drinking water and the local fish that people consume. Fish store mercury without metabolizing it, and people who eat mercury-contaminated fish can contract Minamata disease.

The health of the people and of future generations is not even important enough to study. The people polluting the environment don’t want the effects known. Until there is a serious effort to create a political solution to the problems of the Niger Delta, the people will continue to suffer, and the health and lives of the entire population are in danger. The proliferation of armed mercenaries will only escalate and prolong the problem.

(h/t sdnnigeria’s photostream)

Using PDAs for public health in Zambia

Using PDAs for public health in Zambia

The African Loft has an intriguing article about using open source software on PDAs to collect health data and monitor community health. Titled How PDAs are Saving Lives in Africa, Dr. Joel Selanikio writes:

… through a year-old pilot program, Zambia is replacing paper-based health surveys with those used on PDAs (personal digital assistants). This means no data entry, no cumbersome clipboards, and most importantly no waiting weeks or months for data entry clerks to enter stacks of paper into a computer for analysis.

Zambia today is helping to lead a public health revolution that has the potential to improve the lives of millions of people in the developing world. By switching from paper-based to mobile-enabled digital health systems, Zambian health workers are empowered with new ‘eyes and ears’ in the field-devices that increase the speed and accuracy with which vital health information can be collected and recorded. These PDAs, sometimes more powerful than laptops of the recent past, quickly are becoming a vital public health management tool.

EpiSurveyor operates using a Java-based engine and a Windows-based Designer application that allows fast and easy creation of forms and data systems. It allows anyone with average computer skills–the ability to use a word processor or email, for example–to create and share mobile data collection systems in minutes, and without the need for consultant programmers.

In keeping with its mission to break down the barriers that block access to health data in developing countries, EpiSurveyor is free–anyone with internet access can download the program. EpiSurveyor is also open source, enabling those with higher-level programming skills to manipulate the program to respond to health needs as they arise. Finally, EpiSurveyor is built to run on mobile devices, providing maximum mobility and ease-of-use for health workers who spend most of their time in the field. Pilot project training is conducted using the Palm Zire.

So far, year-old pilot projects in Zambia and Kenya are showing that data received from the field has streamlined the inoculation of children against measles, collected information on HIV, and has even helped to contain a polio outbreak.

This sounds like a powerful, cheap and practical way to manage a lot of public health information functions. It looks well worth further exploration. You can read the entire article here.

Map of Tullow’s recent oil discovery in Ghana
click on the map to see the larger view

The Guardian published an article this week about the oil discovery in Ghana, and potential effect on the Ghanaian economy. Ghana enters oil age with wary eye on neighbors.

.

. . as the euphoria dies down, people are debating whether oil is really the economic injection their country needs.
. . . “Nigeria has oil in abundance, yet the local people have nothing,” said George Moore, a 29-year-old restaurant worker in Axim, a fishing village near Cape Three Point. “Is that what is going to happen here?”
. . .

“Our country works, but the idea of us producing oil still scares me,” said Kofi Bentil, a business lecturer at Ashesi University in Accra. “It will totally change the structure of the economy. It could push us into overdrive, but it could also lead us to self-destruct.”

One advantage that Ghana has over its oil-producing neighbours, said Mr Bentil, is experience and political stability. While countries such as Nigeria were already swimming in oil money at independence, Ghana has had 50 years to build up institutions to manage its finances.

It is also one of the few countries in the region to hold free and fair elections with peaceful transitions of power.

Although corruption at state level remains significant, accountability has improved greatly in recent years, donor officials say.

Mats Karlsson, the World Bank country director for Ghana, said that even without oil, Ghana was on track to become a middle-income country by 2015, when it would start to wean itself off aid. Oil revenues could accelerate that process.

Or, oil revenues could reverse the process.

The US Africa Command could be a destabilizing influence in Ghana as well as other countries. The focus of Africom is oil. Cooperation with African military organizations is an attempt to manage this resource. And the more the interests of the military in a country are supported above the interests of other citizens, the more chance there is of creating and extending coups and military governments. Currently Nigeria, Equitorial Guinea, and other places, are experiencing this kind of US military support. In the words of Vijay Prashad:

Resource wars in the Congo (over diamonds and coltran) and in West Africa (over oil) have set the continent on fire. The U.S. has thus far engaged with these conflicts through Africa’s national armies, who have increasingly become the praetorian guards of large corporations. None of this can be justified directly as a protection of the extraction of resources, so it has increasingly been couched in the language of the war on terrorism. The Pan-Sahel Initiative (created in 2002) draws U.S. Special Operations Forces to Chad, Mali, Mauritania, and Niger. In 2004, the U.S. extended this to the major oil producing countries of Algeria, Nigeria, Senegal and Tunisia and renamed it the Trans-Saharan Counter-Terrorism Initiative. After 9/11, the U.S. moved a Special Operations Force into a former French Foreign Legion base, Camp Le Monier, in Djibouti. In July 2003, the U.S. earned the right to deploy P-3 Orion aerial surveillance aircraft in Tamanrasset, Algeria. Under the guise of the War on Terrorism, the U.S. government has moved forces into various parts of Africa, where they were able to train African armies and to intervene in the increasingly dangerous resource wars.

Ghana needs to diversify her economy, and protect and develop her agricultural sector, if the oil is to help rather than hurt. And Ghana needs to provide health care, and free universal public education. This is a public good, even necessity, and should not be an individual privilege. Ghana needs all its brain power active and healthy, not just the brain power of the rich. Rich brains are not always the best brains. Every cedi invested in education will be paid back many times over in business development and revenues.

As b real points out in a comment, the US Senate has a hearing today on the Africa Command, Exploring The U.S. Africa Command And A New Strategic Relationship With Africa. In his opening remarks there were a few words Senator Feingold said that offer a glimmer of optimism even though the goal is still to acquire African oil and resources. I have emphasized them below.

I am prepared to fully support a unified, interagency U.S. approach that creates a military command with the primary mission of supporting our policies towards Africa and ensuring continued diplomatic, development, humanitarian assistance, and regional initiatives led by the Department of State, USAID, and other key stakeholders – including national and international NGOs, other bilateral and multilateral development bodies, and of course, African political and military leaders.

African leaders look a bit like an afterthought, but at least they are mentioned, unlike in the Bushco documents from the Heritage Foundation that lay out the Bush/Cheney vision of Africom.

I read an interview today with Mike Davis about his book, Planet of Slums. I have copied some key quotes from the article, though I recommend reading the whole article. It has implications for people on every continent. It has relevance to the US and US policies, most immediately in Iraq. It also has particular relevance to West Africa and citizens of the countries of the Gulf of Guinea. Here follow some passages from the interview:

Sadr City, at one point named Saddam City, the Eastern quadrant of Baghdad, has grown to grotesque proportions — two million poor people, mainly Shia. And it’s still growing, as are Sunni slums by the way, thanks now not to Saddam but to disastrous American policies toward agriculture into which the U.S. has put almost no reconstruction money. Vast farmlands have been turned back into desert, while everything focused, however unsuccessfully, on restoration of the oil industry. The crucial thing would have been to preserve some equilibrium between countryside and city, but American policies just accelerated the flight from the land.
. . .
In my book, I looked at the relationship between the pervasive global slum, everywhere associated with sanitation disasters, with classical conditions favoring the rapid movement of disease through human populations; and on the other side, I focused on how the transformation of livestock production was creating entirely new conditions for the emergence of diseases among animals and their transmission to humans.

We have the:

. . . urbanization of livestock . . . millions of chickens living in warehouses, in factory farms. Bird densities like this have never existed in nature and they probably favor, according to epidemiologists I’ve talked to, maximum virulence, the accelerated evolution of diseases.
. . .
At the same time, wetlands around the world have been degraded and water diverted.
. . .
This is a formula for biological disaster and avian flu is the second pandemic of globalization. It’s very clear now that HIV AIDS emerged at least partially through the bush-meat trade, as West Africans were forced to turn to bush meat because European factory ships were vacuuming up all the fish in the Gulf of Guinea, the major traditional source of protein in urban diets.
. . .
the future of guerrilla warfare, insurrection against the world system, has moved into the city. Nobody has realized this with as much clarity as the Pentagon, or more vigorously tried to grapple with its empirical consequences. Its strategists are way ahead of geopoliticians and traditional foreign-relations types in understanding the significance of a world of slums…
. . .
The question of the exchange of violence between the city of slums and the imperial city is linked to a deeper question — the question of agency. How will this very large minority of humanity that now lives in cities but is exiled from the formal world economy find its future? What is its capacity for historical agency?
. . .
Well, here you have an informal working class with no strategic place in production, in the economy, that has nonetheless discovered a new social power — the power to disrupt the city, to strike at the city, ranging from the creative nonviolence . . . to the now universal use of car bombs by nationalist and sectarian groups to strike at middle-class neighborhoods, financial districts, even green zones. I think there’s much global experimentation, trying to find out how to use the power of disruption.
. . . I’ll tell you what I suspect may be the greatest of disruptive powers — the power to disrupt global energy flows. Poor people with minimal technology are capable of doing that across the thousands of miles of unguardable pipeline on this planet.
. . .
The city is our ark in which we might survive the environmental turmoil of the next century. Genuinely urban cities are the most environmentally efficient form of existing with nature that we possess because they can substitute public luxury for private or household consumption. They can square the circle between environmental sustainability and a decent standard of living. I mean, however big your library is or vast your swimming pool, it’ll never be the same as the New York Public Library or a great public pool. No mansion, no San Simeon, will ever be the equivalent of Central Park or Broadway.

One of the major problems, however, is: We’re building cities without urban qualities. Poor cities, in particular, are consuming the natural areas and watersheds which are essential to their functioning as environmental systems, to their ecological sustainability, and they’re consuming them either because of destructive private speculation or simply because poverty pours over into every space. All around the world, the crucial watersheds and green spaces that cities need to function ecologically and be truly urban are being urbanized by poverty and by speculative private development. Poor cities, as a result, are becoming increasingly vulnerable to disaster, pandemic, and catastrophic resource shortages, particularly of water.

Conversely, the most important step toward coping with global environmental change is to reinvest — massively — in the social and physical infrastructures of our cities, and thereby reemploy tens of millions of poor youth.


A recent article by Kwadwo Nketsia in the Accra Mail raises the question of a US base in Ghana once again. I have not read that proposed in any US media recently. However, Bush/Cheney are unlikely to make anything public until they are forced to do so. The speculation I have read is that that a military base and Africa Command HQ may be located in Sao Tome and Principe, which would provide fast and easy access to the entire Gulf of Guinea, or possibly in Morroco. Still, Ghana would have much to offer the US Military, and I think it would be a mistake for Ghanaians to think a US Military base would have much that is positive to offer Ghana.

Ghana has much to be proud of as a sovereign nation. As Nketsia correctly records:

Ghana is said to be among six countries being considered for the location of the military base. We are being considered due to our “true young democracy”, freedom of speech, good governance (which has earned us monetary rewards for MCA projects), and an excellent human rights record, (The Global Peace Index study has ranked Ghana the 40th most peaceful country in the world ) and other positive factors for better development.

All these positives are true. Nketsia’s main argument for the base appears to be economic, paychecks would put money into the local economy, and the base would draw visitors from around the world. He thinks that a base will have a positive effect on health. He should look at the situation in the US, or ask the Philippines about the toxic waste and health care issues Clark AFB left behind.


The U.S. military’s choice to ignore such toxic time bombs in the Philippines has already wreaked havoc on the Philippine people. Hazardous substances in the groundwater continue to migrate into heavily populated towns east of Clark . . . Not merely a sore spot in the relationship between the Philippines and the United States, this toxic disaster threatens people’s basic human right to a clean and healthy environment.

Throughout the United States and around the world people who live in the general vicinity of military bases are in terrible danger:


The contaminants emitted from military bases include pesticides, solvents, petroleum, lead, mercury, and uranium. The health effects for the surrounding communities are devastating: miscarriages, low birth weights, birth defects, kidney disease, and cancer.


The U.S. Department of Defense is the largest polluter in the world, producing more hazardous waste than the five largest U.S. chemical companies combined. . . the burden of health impacts and environmental destruction falls disproportionately on poorer communities, people of color and indigenous communities. Women face particularly severe problems because of their sensitive reproductive tissues and children because their immune systems are not yet fully developed.

This is what Ghana has to look forward to if there is a US Military base situated in Ghana.

Under Bush/Cheney the current military strategy is the long war for oil. The object of the long war is to co-opt and contain oil supplies wherever they might be found around the globe. The recent discovery of oil in Ghana’s territorial waters may have increased US interest in Ghana as a potential US base.

Nketsia also thinks the days of huge military bases are behind us. At present the US African bases are the lily pads he describes, and there is already some base activity in Ghana. But it you look at what the US is still building in Iraq, the new bases planned are even larger than ever. The US version of the colony is the military base. Countries that are home to these bases become occupied territories of the United States. It is a fast way to lose sovereignty.

For comprehensive information about avian flu, what you need to know, and what you may need to do, see the Flu Wiki. The Flu Wiki, fluwikie.com, brings together all the information about avian flu, where it is, what is happening, what you can do, and any other news and developments.

The arrival of bird flu in Tema is most unfortunate. The virus has already circled the globe through the migrations of birds, so it can break out anywhere. If a pandemic flu hits, we can expect around 30% of ourselves and our neighbors to become ill and incapacitated. This will have a devastating effect on commerce, government, the water, food, and energy supplies, because around 30% of the workers will be ill and unable to work. H5N1, when it does effect humans, kills 56% of the people who get it. Luckily, so far, it is not easy for humans to get, although it can be devastating for domestic poultry.

The one circulating now in Asia and Africa and Europe in birds is H5N1, a particularly nasty character that kills more than 56% of those people who get it. While ducks and other birds can get H5N1 and live, it’s especially deadly to chickens and domestic poultry. It’s very difficult to catch, and even more difficult for humans to spread because the receptors in human airways for the current H5N1 are deep in the lungs of humans and not in the nose and throat.
. . .
We don’t fully understand exactly how flu is spread, but the above basics apply. However, should something happen that would make a novel bird flu like H5N1 easier to spread, such as having the virus mutate to a form that likes the nose and upper airway receptors (so that it’s easy to catch and easy to spread by sneezing), or prefers the temperature of the human nose, it could start to spread in a human population.
. . .
This has happened before. in fact, in 1918-9 H1N1 spread around the world, killing 50 million people. There were milder pandemics in 1957 and 1968, and we really haven’t seen one since, at least on that scale. But since we get around three each century, we are due, and that’s why scientists say that a pandemic of some sort is inevitable.

If you are worried about bird flu, can you eat poultry? Here is what the World Health Organization has to say about that:

Is it safe to eat poultry and poultry products?

In areas experiencing outbreaks, poultry and poultry products can also be safely consumed provided these items are properly cooked and properly handled during food preparation. The H5N1 virus is sensitive to heat. Normal temperatures used for cooking (70oC in all parts of the food) will kill the virus. Consumers need to be sure that all parts of the poultry are fully cooked (no “pink” parts) and that eggs, too, are properly cooked (no “runny” yolks).

Consumers should also be aware of the risk of cross-contamination. Juices from raw poultry and poultry products should never be allowed, during food preparation, to touch or mix with items eaten raw. When handling raw poultry or raw poultry products, persons involved in food preparation should wash their hands thoroughly and clean and disinfect surfaces in contact with the poultry products Soap and hot water are sufficient for this purpose.

In areas experiencing outbreaks in poultry, raw eggs should not be used in foods that will not be further heat-treated as, for example by cooking or baking.

Avian influenza is not transmitted through cooked food. To date, no evidence indicates that anyone has become infected following the consumption of properly cooked poultry or poultry products, even when these foods were contaminated with the H5N1 virus.

insecticide-treated bed nets on sale; being retreated; and person sleeping under net.

From the CDC: Insecticide-treated bed nets (ITNs) are now a major intervention for malaria control.

Seven years ago, on April 25th, 2000, African leaders from 44 malaria-endemic countries participated in the first-ever African Summit on Malaria, and declared April 25th as Africa Malaria Day. This year, for the first time, the United States will officially commemorate Malaria Awareness Day, celebrating progress and highlighting opportunities in the fight against malaria. To underscore the U.S. commitment to ending malaria related deaths, President Bush embraced the urgency of the cause by designating April 25th, 2007 as Malaria Awareness Day.

Tom Egwang, the director-general of Medical Biotechnology Laboratories in Kampala, Uganda writes in SciDev.Net that Africa should be the driver, not the co-pilot of malaria vaccine development. He writes:

African researchers in resource-poor countries are as competent and knowledgeable as their Northern partners. They publish research articles in leading peer-review journals, present findings at international conferences, read the same literature and attend the same symposia.

So why aren’t they designing malaria vaccines themselves? The stock response to this — as it seems to be to all Africa’s development challenges — is a lack of funds. But putting pen to paper to design a vaccine does not cost money. It takes creativity and innovation — attributes that we on the continent surely possess.

Getting the policy emphasis right

Effective research and development (R&D) does, of course, need funding. But to say that the lack of malaria vaccine R&D in Africa is due to poverty is a lie.

African governments can afford to buy presidential jets and bail out floundering companies. They maintain huge defence budgets and engage in recurrent military adventurism. These actions cost the continent hundreds of millions of dollars — money that could instead be used to develop malaria vaccines.

Similarly, petrodollar profits from oil-rich states like Gabon, Libya or Nigeria could be used to support malaria R&D efforts within and beyond their own borders.

The European Union — a region that has no malaria — currently supports a multi-million dollar network of excellence in malaria research. These funds could, again, have been better spent supporting R&D efforts in Africa.

Misguided funding policies have been accompanied by lopsided training policies that have created a polarised malaria research world.
. . .
African scientists running R&D projects must make herculean efforts to mentor a new generation of Africans to tackle malaria vaccine R&D head-on. This also means lobbying their governments to invest in research — before the North-South divide becomes an abyss.

University curricula should emphasise product development and entrepreneurship. Strategic partnerships with African organisations like the Uganda Industrial Research Institute would facilitate the development of pilot biotechnology projects.

In this way, products developed by academia could be scaled up on a semi-industrial scale for proof-of-concept studies.

African policymakers have hitherto only paid lip service to African science. They must now embrace it as the engine for socio-economic development in Africa, giving it unequivocal and solid financial support.

Transgenenic mosquito larvae (left and right)
have an antiparasitic protein (green)
that wild insects (middle) lack.

© J. Ito and A. Ghosh

Scientists have developed genetically modified mosquitoes that are unable to transmit malaria. This shows real potential for eliminating malaria bearing mosquitoes, and eliminating malaria, without the use of poisonous insecticides

Scientists believe that genetically modified (GM) mosquitoes could become the latest method of targeting the spread of the deadly disease malaria.

The GM strain of malaria-resistant mosquitoes outcompete their natural counterparts when fed malaria-infected blood, researchers from the John Hopkins University in Baltimore claim.

As such they believe that introducing GM mosquitoes (transgenic) into the environment could help to eventually replace natural mosquitoes.

There are still a number of questions and controversies to be addressed before releasing gm mosquitoes into the wild, but this has huge potential for positive impact on the health and economy of many countries around the world, including Ghana.

Researchers led by Marcelo Jacobs-Lorena at the Malaria Research Institute at Johns Hopkins University in Maryland created genetically modified mosquitoes by giving them a gene that made it impossible for them to pass on the plasmodium parasite that causes malaria.
. . .
Over time, the researchers found that the GM mosquitoes slowly became the majority, reaching 70% in nine generations.
. . .
The finding was hailed as welcome proof that GM mosquitoes, made with cheap laboratory techniques, could ultimately have a greater impact on malaria than chemical sprays and other treatments.
. . .
Trials in sub-Saharan Africa, where malaria claims the life of a child every 30 seconds, could be conducted within five years, but scientists will first have to prove as far as possible that the resistance genes will not trigger a more aggressive form of malaria, or spread to other insects.

At a glance

Malaria kills more than 1 million people a year

90% of malaria deaths occur among young children in sub-Saharan Africa

The disease costs Africa $12bn (£6.2bn) in lost GDP and consumes 40% of public health spending

60% of malaria deaths strike the poorest 20% of the global population

71% of all deaths from malaria are in the under-fives

Children can die within 48 hours after the first symptoms appear


Chernobyl, site of the worlds worst nuclear accident.
20 years later the population still suffers terrible health problems.

Energy experts” are recommending nuclear energy for Ghana. There is renewed interest around the world in nuclear energy, which is perceived as the fastest, easiest, and cheapest way to increase electrical supply in a country.

Nuclear power is a big mistake.

Until now, nobody, in any country, has figured out a safe way to dispose of the nuclear waste from nuclear plants.

This, along with the health hazards, are what stopped the construction of nuclear plants in the United States. Nuclear waste is accumulating in the existing plants and causing health problems in the surrounding neighborhoods. The Bush administration has tried to get nuclear construction started again, but there is still no solution to the waste. It was all supposed to be transported to Nevada and buried. But transporting it across country is terribly dangerous. And there is no way to guarantee that once buried, it will not get into the surrounding land and ground water. Citizens of Nevada and around the country are fighting this with the Nevada Nuclear Waste Task Force.

European countries are already using African countries, and the oceans off the coast of Africa as dumping grounds for nuclear waste.

. . . for the past 15 years or so, European companies and others have used Somalia as a dumping ground for a wide array of nuclear and hazardous wastes.

“There’s uranium radioactive waste, there’s leads, there’s heavy metals like cadmium and mercury, there’s industrial wastes, and there’s hospital wastes, chemical wastes, you name it,” he said. “It’s not rocket science to know why they’re doing it because of the instability there.”

. . .

The Asian tsunami dislodged and smashed open the drums, barrels, and other containers, spreading the contaminants as far away as 10 or more kilometers inland.

. . .

The results of the contamination on coastal populations, Mr. Nuttall says, have been disastrous.

“These problems range from acute respiratory infections to dry, heavy coughing, mouth bleedings, abdominal hemorrhages, what they described as unusual skin chemical reactions,” he noted. “So there’s a whole variety of ailments that people are reporting from these villages where we had a chance to look. We need to go much further and farther in finding out the real scale of this problem.”

And -

Poor countries are victims of that illegal trade, which constitutes a threat to their biodiversity and culture, and hurts their chances for development.


In addition, what guarantees do we have that the plants will be well managed and that inspectors can not be bribed? Accountability is a problem in the United States, which has fairly good inspection regulations and law enforcement. The people who operate the plants in the US are still not always as careful about safety as they should be. They most certainly cannot be trusted without reliable oversight.

Two thirds of the energy produced by nuclear power is waste in the form of heat. It creates thermal pollution in the water supply, such as the Hudson River in New York state. Do we want more water pollution in Ghana?

Ghana should turn thumbs down to nuclear power.

Ghana’s President Kufuor reminds me of the United State’s President Bush. Both preceded their presidencies with a series of unsuccessful businesses. Both appear comfortable with looting the treasury for themselves and their cronies at the expense of the people in their countries. Both countries will likely survive these presidencies. But both will be damaged, and will the voters in both countries have the wisdom and the will to choose better leadership?

In many areas where Ghana was a leader 50 years ago, she has fallen behind. The most critical of these areas are education and health care. A healthy and educated population is the foundation of successful business and development. The best thing Ghana could do to improve her position in the world is bring back free universal public education. As an article on GhanaWeb points out:


Socially, Ghana’s government says the country has made strides in both health and education.

KSP Jantuah, disagrees.

“A child from a poor family had a better chance of going to a good school then than now”, he told AFP.

“We made (primary) school free and compulsory.

After the coups people had to start paying again”, he said, insisting that the same applies to health care.

If Ghanaian businesses wish to grow and expand, the best thing they can do is work to restore and expand access to education and health care.

Former U.S. President Jimmy Carter, Deputy Executive Director of UNICEF Kul C. Gautam, and Director-General of WHO Dr. LEE Jong-wook, examine a Guinea worm patient. photo by A Poyo

And Ghana is not doing very well with its eradication efforts. In fact it is the only country that the Carter center has been working with whose efforts to eradicate guinea worm disease, also called Dracunculiasis, or GWD, have gone backwards.

As President Carter says:


Greetings from Ghana. We departed en route to Accra Tuesday afternoon with a mixture of anticipation and trepidation. Ghana was the first country in which Rosalynn and I ever visited endemic villages, and we’ll never forget seeing two-thirds of the total population incapacitated with the disease, many of them lying around under shade trees unable to walk. I described the scenes in my first message in this series.
. . .
There has been stagnation in Ghana’s efforts since then, and in the last three years the number of cases reported has risen from 4,739 to 8,283.
All nations except Ghana have made significant and steady progress in recent years, resulting in a total reduction . . . (of) -more than 99 percent.
. . .
The most disturbing event occurred last year when a serious outbreak of Guinea worm in the central section, around Lake Volta, was deliberately concealed. Solemn promises by the government to dig wells have not been honored. The Carter Center has marshaled a series of exceptional efforts to overcome these problems, but all have been fruitless. There is no doubt that our visit is timely, but we have received word that top officials are very concerned about our potential criticisms. Some intense observation, incisive analysis, and political diplomacy will be necessary.


So what is the reason Ghana has fallen backward. I think there has been a general neglect of health care and health care workers by the present government, based on what I hear from talking to people in Ghana. Kufuor had not responded to letters that Carter wrote before his trip, but did have a friendly meeting with Carter while he was in Ghana. In addition, as Carter writes, Ghanaian officials have been emphasizing borehole wells as a way of eradicating guinea worm. This will not necessarily eradicate the worm, and much simpler, cheaper, and more accessible technologies are at hand. Filtering drinking water through a cloth is a principle technique of effective eradication. In fact, the Carter delegation watched a
demonstration of filtering water and the application of Abate (a larvicide that kills the intermediate host, a water flea, that carries eggs.)


It became increasingly obvious to me that a basic problem was that Ghana’s officials, from field workers to the president, considered the drilling of deep borehole wells as the primary solution to the Guinea worm problem. The common theme was “a deep well will eradicate our Guinea worms.” Although highly desirable and much needed in every village, this is not the way to eradicate the disease. Extremely expensive and time-consuming, with no assurance of finding potable water in many areas, the borehole dream had become a substitute for simple filtering of each drink and keeping people with emerging worms out of the ponds.

Most communities throughout the world have eradicated Guinea worm without drilling a well, and many people are still infected even when blessed with a good underground source of water. Just stopping by the local pond for one drink is all it takes. I explained this to them in very strong terms, had the ministers adopt the same sermon for our joint press conference, and we continued this explanation during our very pleasant visit with President Kufuor when we returned to Accra.

When all our meetings had been completed, we felt that a new day may have come to Ghana in its eradication effort.

I certainly hope this is the case. There is no excuse for the problem of guinea worm worsening in Ghana. Ghana has the means and should be able to take the lead in eradication efforts. You can read President Carter’s remarks on Ghana, and on the other countries he visited this February here, and view the slide show of his visit to Ghana.

Information on guinea worm from the US CDC can be found here, you can view an illustration of the life cycle of the worm, and recent reports.

Mr Kwesi Dzidzienyo, IFESH/Ghana Country Representative, presenting medical
supplies to the Tetteh Quarshie Memorial Hospital, Mapong-Akwapim.

The February 1 issue of the New England Journal of medicine has an article by Fitzhugh Mullen MD about the flight of Ghanaian professionals out of Ghana, to the United States and Europe. Doctors and nurses can make a lot more money in the US or UK.

“It’s the same for football players as it is for doctors,” I was told by Tsiri Agbenyega, dean of the medical school in Kumasi, Ghana. “We have to train a lot more than will end up in Ghana, because they all leave. The football players go to Europe, and the doctors to America and the U.K.” Agbenyega spoke with a mixture of frustration, pride, and resignation. He was pleased that Ghanaian athletes and physicians were competitive internationally, but their success meant a loss to the country — a loss more problematic in medicine than in football.
. . .
Ghana has a strong tradition of education, a public health system that has resulted in greater longevity and lower infant mortality than in much of West Africa . . . If Ghana could show the way, one might think, other African countries might be able to follow.
But not so. For much of the past decade, health improvement in Ghana has been at a standstill . . . Today, there are 532 Ghanaian doctors practicing in the United States. Although they represent a tiny fraction of the 800,000 U.S. physicians, their number is equivalent to 20% of Ghana’s medical capacity, for there are only 2600 physicians in Ghana. An additional 259 Ghanaian physicians are in practice in the United Kingdom and Canada — and this group includes only those who have successfully been licensed after leaving Ghana.
. . .
“Our only recourse is to try to train more in the hopes we will keep more,” explained Yaw Boasiako of Ghana’s Ministry of Health, who outlined an ambitious plan for doubling the number of physicians and nurses educated in the next few years. Ghana, like many English-speaking developing countries, is caught in an educational conundrum: the better the quality of their universities and the more health professionals they train, the more they lose to the United States and the United Kingdom. They have a leaky bucket now. In desperation, they’re building a bigger leaky bucket.

But that’s not all they’re doing. As in most developing countries, the private medical sector is small, and most physicians work for the government health service, which staffs the public hospitals and clinics where most people receive care. Although the salaries of Ghanaian doctors are better than those in many African countries, doctors are quick to point out that their pay is still modest. “A trained physician can make more in London in two months than we can make in a year in Ghana,” I was told frequently.
. . .
To augment physicians’ services, the ministries of health and education are expanding training opportunities for community health nurses, technical officers, and “medical assistants” — midlevel practitioners who substitute for doctors in shortage areas. For many years, the Rural Health Training School in Kintampo has provided experienced nurses with a year of advanced training and 6 months of internship to enable them to function independently as medical assistants. The school is doubling its class size to 200 but is changing to a non-nurse model, since the loss of nurses to emigration has depleted the ranks of program candidates. In the future, medical assistants will be secondary-school graduates who will receive 3 years of didactic training followed by a year of internship. Although all health care workers are subject to the pull of emigration, the global market for midlevel practitioners is not standardized, and the government hopes that most medical assistants will remain in Ghana.

. . . the single most important contribution that the United States could make would be to train more doctors at home . . . For 25 years, the number of students admitted to U.S. allopathic medical schools has remained constant, while the number of physicians we import has climbed steadily. Without ever enunciating a strategy of dependence on the world, we have created a huge U.S. market for physicians educated elsewhere, inadvertently destabilizing the medical systems of countries that are battling poverty and epidemic disease.

A commitment in the United States to ramp up medical school opportunities to a level closer to national needs would do much to slow medical migration and bring stability to medical programs in poorer countries. Perhaps soccer players will always migrate to the elite leagues of the world, but if doctors and nurses stayed closer to home, lives would be saved.

I would add that although medical professionals may be able to make a lot more money in the US or UK, there is a good chance they can live a lot better and more enjoyably in Ghana. At the same time, the Ghana government has to pay good professional salaries, and pay them on time.

The US should educate more of its own doctors and nurses. Unfortunately the Republican education policies of the last several decades have severely damaged US educational resources and opportunities. I’m hoping the tide is finally turning on this, but nothing is going to happen very fast.

Read the whole NEJM article: Doctors and Soccer Players — African Professionals on the Move.

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