Book Review: Radio Congo: Signals of Hope from Africa's Deadliest War

Radio Congo: Signals of Hope from Africa's Deadliest War by Ben Rawlence 

My 2nd "guy going to Africa" book in the past month. This was the better of the two (or perhaps just the more relevant and contemporary). 

I've never been to sub-Saharan Africa before, and I have no real idea of what to expect, which is what makes these books interesting at the moment. This was well-written and engaging. It did a good job of giving color to daily life in the Congo. The characters (both African and European) were all a bit hollow still, but they had some level of complexity and I enjoyed his ability to write about individuals as individuals rather than archetypes. I didn't find his observations to be super insightful, but the writing was lively, and I enjoyed traveling along on his adventure. 

Book Review: The Making of a Tropical Disease: A Short History of Malaria

The Making of a Tropical Disease: A Short History of Malaria, by Randall M. Packard 

This was disappointing. I'm not sure how many times a book can re-write variations of the sentence, "Changing social and economic conditions transformed the ecological relationship of malaria parasites and human hosts, resulting in a decline/increase in malaria burden," but the author exceeded his allotment by quite a bit.  It's a useful point, and one well worth making, but I'm not sure if I've ever read a book that hammers its point so repetitively. 

Also, I'm not sure that it is a very productive argument.  Yes, improving social and economic conditions would be great for decreasing malaria, but no one argues that we shouldn't improve social and economic conditions for people around the world.  While we're working for social and economic betterment, what can we do to manage and control malaria rates as efficiently and effectively as possible?  Here the book is disappointingly quiet.  There are many discussions of failed malaria programs, but few examples of effective programs that could be repeated or adapted by poor governments in developing countries. 

This book had some useful information, and it wasn't a total waste of time, but I'd only recommend it to someone desperate to gain a bit of background on malaria and willing to plow through a lot of tedium to gain that basic background.  

Making development work: from farms to factories

Charles Kenny's article about the importance of "real" jobs is the most interesting thing on development that I've read in the past few months:

But worldwide, by far the most common way out of poverty in rural and urban areas alike is getting a job working for a company... Having a regular, paying job "may thus be the most important difference between the poor and the middle class," conclude Banerjee and Duflo. 

"Well paid" and "good" are relative terms when it comes to unemployment on a global scale... Nonetheless, these jobs are still better than other options--such as begging or hawking on the street or subsistence farming.  

So for all of the grind of the 9-to-5, the great majority of the planet would be absolutely delighted to get a position with regular hours and a regular paycheck.  And successful economic development--significantly raising incomes above subsistence--is about helping people achieve that dream...  In the long term, economic development is about moving millions off the small farm and into jobs.   

 

Adventures in West Africa

Last winter, I applied for a Fulbright Public Policy Fellowship in the Cote d'Ivoire.  I was applying to a few positions at the time, and I wasn't really expecting much to come of it.  But I got called back for an interview in May and then I was recently informed that I'd been selected as a Fulbright Fellow.  It was too good an opportunity to pass up.  Sheila and I have been craving another adventure, and this is exactly the sort of work that I want to do in my career.

So we're going to the Cote d'Ivoire this September.  The fellowship lasts for 10 months, so ostensibly, I'll be in Abidjan (the de facto capital) from this September until July 2014.  Sheila will come out for my first two weeks in September, and then join me at the end of 2013 for several months.  She's still negotiating with her work, but ideally she'll be able to come out for about five months and work remotely at a reduced schedule.

The fellowship itself sounds amazing.  It's a new program, now called the Fulbright-Clinton Fellowship.  According to the State Department website:

Fulbright-Clinton Fellows serve in professional placements in foreign government ministries or institutions. Fellows gain hands-on public sector experience in participating foreign countries while simultaneously carrying out an academic study/research project.

Fulbright-Clinton Fellows will function in a “special assistant” role for a senior level official. The goal of the professional placements is to build the Fellows’ knowledge and skills, provide support to partner country institutions, and promote long-term ties between the U.S. and the partner country.

For my fellowship, I'll be working in the Ministry of Health in Abidjan as a special assistant to an official there.  It's still unclear who exactly I'll be working for, but I should hear more about that in the next few weeks.

I recently attended orientation in here in DC, and it was really inspiring, probably the first orientation I've been to that made me more excited about the job.  The people were great; all had fascinating back stories and it sounds like they'll be doing really cool stuff.  It was also useful getting to talk to the returning Fulbright alums, especially those coming back from Cote d'Ivoire.  It seems like they had great experiences and that Cote d'Ivoire was the model program among the inaugural class of Fulbright-Clinton Fellowships.  My Fulbright predecessor in the Ministry of Health conducted a couple of really cool sounding health system studies and initiated a project to rebuild the national public health library.

So I leave in September.  I'm still figuring out flights and housing and vaccinations, but I'm really excited.  I'm curious to see who I'll be working for and what they'll be like.  This is likely the single biggest factor in how successful an experience I'll have, so I'm hoping to get lucky.  Either way though, it sounds like I'll have a lot of autonomy, and that a big part of my experience will be the interchange with colleagues at the Ministry of Health.  In addition to regular work projects, last year's alums taught English to colleagues and also gave lessons on computer skills such as using Google Calendar, Excel, Word and Dropbox.  I would love to be able to have some sort of policy impact, but in many ways I think the exchange of institutional knowledge will be just as important.  I'll be in a strange and unfamiliar situation, and I'm looking forward to learning everything I can about the Cote d'Ivoire health system and about life in Abidjan.

Finally, a word about the future of this blog: for my handful of readers (Hi Dad!), fear not! I will continue to post while in Abidjan.  In fact, I'm hoping to blog more than ever.  My field of work will be changing, so I'll likely be blogging a bit more about African and global health issues, and less about U.S. health care.  But this will be a good thing; it will give me a fairly unique blogging perspective and a fun niche.  If there is a health policy blog about West Africa, I have not been able to find it.  This blog may also become a bit more personal.  I anticipate having some novel and interesting experiences working in health policy in Cote d'Ivoire, and I intend to share some of them.

What are the major medical advances of the past decade?

The past few decades have been a bit disappointing in terms of medical advances. Cancer is still a big problem, there's no cure for AIDS, and we somehow don't really understand how to help people lose weight.  But the DMCB argues that, while medical advances have been disappointing, there have been some major breakthroughs in health care delivery.  I would argue that a lot of these are closer to "potential" or "future" advances, and that some will not generate big changes. But this is a handy list and a fun look at how the health care sector will change going forward: 

1. Downjobbing: many tasks that were restricted to highly trained specialists are increasingly being performed by non-physicians, patients and technology.

2. Social Media: patients can not only access the internet for information, they can use the internet to pool input and solicit personalized advice from like-minded individuals

3. Democratized Artificial Intelligence: In addition to social media, we’re on the verge of being able to remotely access AI to generate a reasonably accurate list of diagnoses, suggested tests and recommended do-it-yourself treatments that include the option of doing nothing.

4. The Decline of the Credential: while the academic-industrial complex will continue to churn out superbly trained physicians, massive on-line education will enable persons to gain a surprising level of lay-expertise. 

9. Medical Tourism: As the rest of the globe imports the best that western medicine has to offer minus the United States’ overhead costs, the cost of overseas air travel is no longer be an impediment to patients or insurers.

The full list is here.  

Facts on the "hidden" epidemics of the developing world: road deaths, alcohol, and non-communicable diseases

This article from Oliver Balch in the Guardian is chock-full of interesting (and depressing) facts and thoughts:

• "Accidents on the road are expected to become the biggest killer of children between five and 15 by 2015, outstripping malaria and Aids."
• "Road traffic deaths in sub-Saharan Africa are predicted to rise by 80% by 2020, according to a World Bank report."
• "An estimated 24.1 people per 100,000 are killed in traffic accidents every year, according to the bank." 
• "Though seven in 10 adults abstain from drinking alcohol in sub-Saharan Africa, those who do have the highest prevalence of heavy episodic drinking globally." 
• "A study of police reports in Nigeria between 1996 and 2000 found that half of all car crashes involved drink-driving."
• "Between 2001 and 2008, funding for cancer, heart disease and diabetes in developing countries grew sixfold... Even so, programmes to combat NCDs comprise less than 3% of global development assistance."

Will Uruguay's marijuana legalization be a policy success?

Uruguay's House of Representatives have passed a bill to legalize marijuana.  It seems likely to become law.  It still has to pass through the Senate, but the Senate has an even greater left-wing majority than the House of Representatives, and the bill has the support of Uruguay's President Jose Mujica.  The BBC reports:  

The measure is backed by the government of President Jose Mujica, who says it will remove profits from drug dealers and divert users from harder drugs.

Under the bill, only the government would be allowed to sell marijuana.

The state would assume "the control and regulation of the importation, exportation, plantation, cultivation, the harvest, the production, the acquisition, the storage, the commercialisation and the distribution of cannabis and its by-products".

I once proposed legalizing and nationalizing the marijuana industry as a sort of radical centrist joke, a policy that would offend the conservatives (legalize drugs), the libertarians (let the government sell it), and the liberals (because government is so bad at running things).  Somehow Uruguay is on the verge of implementing this idea.  

It's worth noting that, unlike legalization efforts in the U.S., which have come about through voter referendums, the Uruguayan government seems to be running out ahead of its population: 

A survey carried out before the vote by polling organisation Cifra suggested 63% of Uruguayans opposed the bill.

I nevertheless support the measure and I'm fascinated to see what sort of effects the new law will have.  That being said, it will be difficult to measure the impacts of this bill.  Marijuana-related deaths could rise, but the measure would still be a success if a) alcohol-related deaths declined; or b) illicit trade is significantly reduced, thus taking money from drug traffickers or reducing drug-related violence and death.  These latter effects would be particularly difficult to measure, so there should be plenty to argue over for years to come.  Also, it is possible the government could use income from the new industry to good effect via social programs.