In the Life of...

Four Transplant Recipients Contract H.I.V.

From the New York Times
By DENISE GRADY
Published: November 13, 2007

Four transplant recipients in Chicago have contracted H.I.V. from an organ donor, the first known cases of the virus being spread by organ transplants in 22 years, the Chicago Tribune is reporting today.

The patients also contracted the hepatitis C virus.

The organ donor tested negative for both diseases health officials said — apparently because the donor was infected too recently for commonly used blood tests to detect the infection. Those blood tests do not find the virus itself; they look instead for the body’s reaction to the infection — antibodies produced by the immune system.

But the body takes time to react, and if the test is done too soon — within 22 days of infection — the antibodies may not be detected. Doctors say that is what probably occurred these cases.

It has always been known that this kind of transmission was theoretically possible, but it was considered highly unlikely. And indeed, 400,000 transplants have occurred without any previous reported cases of H.I.V. transmission.

Another type of test can pick up viral infections earlier, but it was not used on this donor.

The organ donor was known to be at high risk of being infected with H.I.V., officials said, but the nature of the risk was not disclosed, nor was the cause of death. Federal guidelines recommend against transplanting organs from high-risk people, unless the recipients are so likely to die for want of a transplant that the chance of transmitting H.I.V. seems a lesser threat. There is a shortage of organs for transplant, and many patients die on the waiting list.

The Centers for Disease Control and Prevention is investigating the case.

The Future of Africa

Is Monetary Funding the Best Solution to Africa’s Impending Health Issues?

For several decades America, as well as other nations, has generously given to numerous third world countries in Africa to fight against poverty and infectious disease. Whether through canceling national debt, providing aid through healthcare, or through medical supplies and community building, countries like Uganda, Malawi, and Sudan have reaped little from these efforts. In fact, most countries in Africa are no better off then when we first decided to step in. All these efforts are of good intent and well needed, but does money address the heart of the problems that exist in Africa? It seems as though the natives that were trained a decade ago are no longer working in their local communities and villages, but have moved abroad to use their education to open the door to more opportunities.

This raises important concerns regarding our efforts to aid in the welfare of other countries. Is monetary funding the best solution to Africa’s impending health issues? I hope to answer this question by revealing the situation around Uganda’s tragic history.

War has ravaged so many countries and so many lives in Africa. The 19-year civil war in northern Uganda has resulted in the displacement of at least 1.5 million people. War has devastated the minds, hearts, and vitality of the Acholi people, an ethnic group who endure life among the harshest of circumstances. “The Acholi people have witnessed 20,000 of their children abducted to fight as child soldiers, 1,100,000 civilian deaths, and the migration of 1.8 million people into internally displaced people’s (IDP) camps.” Current international aid only meets 43% of the amount needed to provide basic humanitarian assistance. Healthcare reform was needed badly in Uganda, to bring some semblance of organization and productivity.

Health reforms based on market principles have been introduced widely in both developed and developing countries over the past 20 years. In developing countries, international donors have insisted on health reform as a precursor to providing external aid. Uganda started market based health reforms in 1994. These reforms have not only failed to improve the health of people and their community services, but have arguably been the key driving force in their demise. These reforms presented themselves in the form of decentralization of the Ministry of Health to local authorities and individuals.

Even though many praised Uganda’s decentralization, it also introduced many obstacles. This is because money given by contributors was restricted to specific uses. Decentralization has actually widened disparities in the nature and quality of health services. For instance, The availability of emergency obstetric services now varies from 4% to 42%. This is because the richer districts and those with powerful local politicians who have been able to persuade nongovernmental organizations to work in their district have done better. Performance of health services fell after the introduction of these reforms, and key health statistics from 1990-1995 to 2000-2004 have worsened.

Uganda has failed to achieve a functioning health system. In fact, almost 20 years of civil war has caused health experts to fear another impending HIV epidemic. Uganda is regarded as an HIV/AIDS success story. Uganda has become the only African country where HIV rates have declined. However, some health experts fear that the civil war with the Lord’s Resistance Army (LRA) will reverse advances made in the past several years.

The north has suffered the brunt of the war. This war is the result of tension between northern and southern Uganda that has existed since pre-colonial times. Like Rwanda, colonialism institutionalized these differences by dictating distinct occupational roles. Northern Ugandans were assigned to military positions, and southern Ugandans were given privileged public services. When Uganda gained it’s independence in 1962, radical regimes exacerbated these differences, causing tension; this tension continued to grow when the LRA was established and determined to target the Acholi people.

The majority of people affected are children. Consequently, mortality rates are high in Uganda. Children are forced from their homes, either to fight in the war, or to commute nightly to avoid capture from the army rebels.

They come in with their bedding under their arms; some are already in their uniforms ready to go to school in the morning. These ‘night commuters’ walk up to 10 kilometers to seek refuge. Many are forced to sleep on the street, increasing the risk of abuse and sexual exploitation.

Almost 15,000 children flood into town every night, sent by their parents, who fear they may be abducted, to sleep in safety. Young women who are abducted are forced to become wives to the rebels, and are savagely raped and disfigured. These actions increase HIV infection and cause increased risks for infectious diseases. How does healthcare reform save these children? How does canceling national debt keep these children safe at night? Where is education where you need it most?

This savage war has deteriorated every aspect of what so many people have been working for:

Civil war disrupted agriculture and trade in Uganda and Sudan. This reduced tax revenues and drained scarce resources away from health budgets to finance increased military expenditures. Hundreds and thousands of people were driven from their homes either as internally displaced people or as refugees. Normal health service delivery systems were broken down forcing doctors, nurses and other health professionals into towns, cities or neighboring countries in search of peace and employment. Scores of hospitals, health centers and dispensaries were abandoned, destroyed or looted, rendering even the limited physical facilities useless. Preventive public health services such as immunization and provision of potable drinking water were discontinued, leaving huge populations susceptible to controllable infectious diseases and epidemics.

There are several approaches to what needs to be done in countries like Uganda to aid in improving lives and healthcare. The intent behind these ideas I believe is pure, however, we must keep in mind that we are dealing with another culture, radically different from ours. And our greatest idea may be their greatest failure.

The first of these approaches is revealed through the eyes of the celebrity. We live in an age where it is popular to be charitable. Through celebrities such as U2’s Bono, Angelina Jolie, and George Clooney, the media has opened America’s eyes to some of what goes on in these war torn countries like Uganda. Through such efforts as The One Campaign, celebrities have rallied together, urging us to sign petitions and show our government our discontent, demanding that they cancel national debt to these countries, or increase monetary aid.

Bono believes that he has the solution to Africa's problems. In fact, he is proclaiming it so loud that people seem to trust his answers. He traveled in 2002 to Africa with former Treasury Secretary Paul O'Neill, urging debt forgiveness. He recently had lunch at the White House, where he reiterated the "more money" proposal, and how African countries are “uniquely futile.”

It seems to have been Africa's fate to become a stage of empty talk and public gestures. And into this empty pit we keep throwing our money, hoping that something will change. But the impression that Africa is fatally wounded and can only be saved by outside help - not to mention celebrities and charity concerts - is a destructive and misleading idea.

Similar to this, major corporations have decided to take a similar approach to rising up the vitality of the African nation. Bill Gates has said numerous times that he wants to rid himself of his “burden of billions.” In fact, Bono is one of his trusted advisors. Mr. Gates wants to send computers to Africa. But is this what the people in Uganda, Malawi, or Sudan need? Low-income schools in America might need computers, but are they not somewhat impractical in a developing country? Wouldn’t it be more prudent to send pencils and paper for children to write with? Mops and brooms to clean with and keep things sanitary? These items are truly needed, not some desktop computer that they would do better off selling then learning how to use. How can we even think about computers when community health centers are having trouble remaining open, or potable water is nowhere to be found for miles?

The other side of the coin represents non-profit organizations. A program that has brought a great amount of change to other nations is the Peace Corps. A government operated non-profit, the Peace Corps sends Americans all over the world to help and educate people in developing countries and aid in disaster relief. But has the change brought about by this program been fruitful? Disaster relief, without question, is an amazing gift we can offer other countries, but is sending foreigners to another country for a fixed amount of time for education really beneficial? What happens when those people leave the program to move on with there day to day lives? Who is to take their place? Teaching in Africa is considered a sub-par occupation, one that is almost looked down upon.

Paul Theroux, an established author and a former Peace Corps volunteer who served in Malawi, describes the frustration that is present in so many countries in Africa:

In the early and mid-1960's we believed that Malawi would soon be self-sufficient in schoolteachers. And it would have been, except that rather than sending a limited wave of volunteers to train local instructors, for decades we kept on sending Peace Corps teachers. Malawians, who avoided teaching because the pay and status were low, came to depend on the American volunteers to teach in bush schools, while educated Malawians emigrated. When Malawi's university was established, more foreign teachers were welcomed, few of them replaced by Malawians, for political reasons. Medical educators also arrived from elsewhere. Malawi began graduating nurses, but the nurses were lured away to Britain and Australia and the United States, which meant more foreign nurses were needed in Malawi.

Now 40 years later, most of these schools lie in ruin, covered with graffiti and weeds, with windows broken. Money will not fix this.

This represents the root of disadvantage that Africa has begun to experience. Our effort to help develop Africa into a thriving continent has had the opposite effect. We have only crippled an already hurting nation. Forcing them to depend on us for aid and relief.

If debt relief and funding is not the answer to reviving these countries, then what is a viable solution? I believe this can be answered by looking at the country of Ireland. In an article in the New York Times, Paul Theroux looks at Ireland as a possible model and solution to the birthing pains seen in developing Africa.

Ireland was characterized for centuries by famine, religious conflict, civil tension, unruly families, overbearing clan chiefs, malnutrition, failed crops, ancient orthodoxies, dental problems and fickle weather. This describes numerous countries in Africa. And like Ireland, absentee European landlords colonized many of these African countries. For many years the Irish were fleeing from their country in droves. Emigration was horrendous during times of famine and disease. In fact, only recently were you legally allowed to buy condoms in Ireland, or divorce. Yet, just like in Malawi, beer is easily available. Ireland, in essence, was the Malawi of Europe.

After centuries of wishing themselves onto other countries, the Irish discovered, like other nations, that education, rational government, people staying put, and diligence could turn Ireland from a crippled, isolated country into a prosperous nation. The Irish found that there was something to be said for staying home. And, when stripped to the basics, this is what Africa needs.

It does not occur to anyone to encourage Africans themselves to volunteer in the same way that foreigners have done for the past 40 years. There are many well-educated and capable adults in Africa who could have a much greater impact and push change to a greater extend then any Peace Corp volunteer.

Therefore, sending more teachers would be futile. I would expect Africans themselves to stay and teach. Theroux presents a great idea on how to encourage people to do this: “There ought to be an insistence in the form of a bond, or a solemn promise, for Africans trained in medicine and education at the state's expense to work in their own countries.” This is a widely used method here in the United States to insure small, rural communities of local doctors available in their towns. Medical schools will often give students full-ride scholarships in exchange for staying locally to practice medicine.

If they say that all roads lead to Rome, then in the case of Uganda and many neighboring countries, it seems that all roads lead out of Africa. It is depressing to think that it is easier for many Africans to travel to New York or London than to their own homelands. “Much of northern Kenya is a no-go area; there is hardly a road to the town of Moyale, on the Ethiopian border. Western Zambia is off the map, southern Malawi is terra incognita, and northern Mozambique is still a sea of land mines.” However, it is pretty easy to leave Africa. According to a recent World Bank study, the emigration to the West of skilled people from small to medium-sized countries in Africa has been disastrous.

I believe that Africa does not have a shortage of capable people, or even money. And dumping more money in the same way we have for years is not only wasteful, but also harmful. We are not the solution to Africa’s problems; the African people are the solution. We must merely act as enablers not saviors. Doing so has tarnished Africa’s belief in itself.

Africa is a beautiful nation, more beautiful, more peaceful, more resilient, and more self-sufficient than we give it credit for. Only the people of Africa can sustain their nation. Without seeing the worth and greater good of empowering them to change, our efforts are useless. Money does not accomplish this, but only a strong resolve among the African people to promote change and educate generations to come so that one day the potential that rests in their hands will be achieved.

Christian Aid. Uganda’s war against HIV/AIDS threatened by continuing civil war.
http://www.christian-aid.org.uk/index.htm. November 24, 2003.

Dodge CP, Health implications of war in Uganda and Sudan. www.PubMed.gov. PMID:
2122523, Soc Sci Med. 1990;31(6):691-8.

Government of Uganda. Status of emergency obstetric care in Uganda. A national needs
assessment of EMOC indicators. Kampala: Ministry of health, 2003.

Health Action in Crises, Uganda: Saving Lives and Reducing Suffering, World Health
Organization, Geneva, 2006

Okuonzi, Sam Agatre. Learning from failed health reform in Uganda. www.bmj.com.
November 13, 2004.

Theroux, Paul, The Rock Star’s Burden. The New York Times. Dec. 15, 2005

Westerhaus, Michael. Uganda: and uncivil war. BMJ Publishing Group Ltd. April 2006.

Ireland a model for Africa?

I read this article in the New York Times this morning...What a great article...and sheds some needed light on the real problems Africa is facing in todays evolving culture. Enjoy

The Rock Star's Burden

By PAUL THEROUX

Published: December 15, 2005

THERE are probably more annoying things than being hectored about African development by a wealthy Irish rock star in a cowboy hat, but I can't think of one at the moment. If Christmas, season of sob stories, has turned me into Scrooge, I recognize the Dickensian counterpart of Paul Hewson - who calls himself "Bono" - as Mrs. Jellyby in "Bleak House." Harping incessantly on her adopted village of Borrioboola-Gha "on the left bank of the River Niger," Mrs. Jellyby tries to save the Africans by financing them in coffee growing and encouraging schemes "to turn pianoforte legs and establish an export trade," all the while badgering people for money.

It seems to have been Africa's fate to become a theater of empty talk and public gestures. But the impression that Africa is fatally troubled and can be saved only by outside help - not to mention celebrities and charity concerts - is a destructive and misleading conceit. Those of us who committed ourselves to being Peace Corps teachers in rural Malawi more than 40 years ago are dismayed by what we see on our return visits and by all the news that has been reported recently from that unlucky, drought-stricken country. But we are more appalled by most of the proposed solutions.

I am not speaking of humanitarian aid, disaster relief, AIDS education or affordable drugs. Nor am I speaking of small-scale, closely watched efforts like the Malawi Children's Village. I am speaking of the "more money" platform: the notion that what Africa needs is more prestige projects, volunteer labor and debt relief. We should know better by now. I would not send private money to a charity, or foreign aid to a government, unless every dollar was accounted for - and this never happens. Dumping more money in the same old way is not only wasteful, but stupid and harmful; it is also ignoring some obvious points.

If Malawi is worse educated, more plagued by illness and bad services, poorer than it was when I lived and worked there in the early 60's, it is not for lack of outside help or donor money. Malawi has been the beneficiary of many thousands of foreign teachers, doctors and nurses, and large amounts of financial aid, and yet it has declined from a country with promise to a failed state.

In the early and mid-1960's, we believed that Malawi would soon be self-sufficient in schoolteachers. And it would have been, except that rather than sending a limited wave of volunteers to train local instructors, for decades we kept on sending Peace Corps teachers. Malawians, who avoided teaching because the pay and status were low, came to depend on the American volunteers to teach in bush schools, while educated Malawians emigrated. When Malawi's university was established, more foreign teachers were welcomed, few of them replaced by Malawians, for political reasons. Medical educators also arrived from elsewhere. Malawi began graduating nurses, but the nurses were lured away to Britain and Australia and the United States, which meant more foreign nurses were needed in Malawi.

When Malawi's minister of education was accused of stealing millions of dollars from the education budget in 2000, and the Zambian president was charged with stealing from the treasury, and Nigeria squandered its oil wealth, what happened? The simplifiers of Africa's problems kept calling for debt relief and more aid. I got a dusty reception lecturing at the Bill and Melinda Gates Foundation when I pointed out the successes of responsible policies in Botswana, compared with the kleptomania of its neighbors. Donors enable embezzlement by turning a blind eye to bad governance, rigged elections and the deeper reasons these countries are failing.

Mr. Gates has said candidly that he wants to rid himself of his burden of billions. Bono is one of his trusted advisers. Mr. Gates wants to send computers to Africa - an unproductive not to say insane idea. I would offer pencils and paper, mops and brooms: the schools I have seen in Malawi need them badly. I would not send more teachers. I would expect Malawians themselves to stay and teach. There ought to be an insistence in the form of a bond, or a solemn promise, for Africans trained in medicine and education at the state's expense to work in their own countries.

Malawi was in my time a lush wooded country of three million people. It is now an eroded and deforested land of 12 million; its rivers are clogged with sediment and every year it is subjected to destructive floods. The trees that had kept it whole were cut for fuel and to clear land for subsistence crops. Malawi had two presidents in its first 40 years, the first a megalomaniac who called himself the messiah, the second a swindler whose first official act was to put his face on the money. Last year the new man, Bingu wa Mutharika, inaugurated his regime by announcing that he was going to buy a fleet of Maybachs, one of the most expensive cars in the world.

Many of the schools where we taught 40 years ago are now in ruins - covered with graffiti, with broken windows, standing in tall grass. Money will not fix this. A highly placed Malawian friend of mine once jovially demanded that my children come and teach there. "It would be good for them," he said.

Of course it would be good for them. Teaching in Africa was one of the best things I ever did. But our example seems to have counted for very little. My Malawian friend's children are of course working in the United States and Britain. It does not occur to anyone to encourage Africans themselves to volunteer in the same way that foreigners have done for decades. There are plenty of educated and capable young adults in Africa who would make a much greater difference than Peace Corps workers.

Africa is a lovely place - much lovelier, more peaceful and more resilient and, if not prosperous, innately more self-sufficient than it is usually portrayed. But because Africa seems unfinished and so different from the rest of the world, a landscape on which a person can sketch a new personality, it attracts mythomaniacs, people who wish to convince the world of their worth. Such people come in all forms and they loom large. White celebrities busy-bodying in Africa loom especially large. Watching Brad Pitt and Angelina Jolie recently in Ethiopia, cuddling African children and lecturing the world on charity, the image that immediately sprang to my mind was Tarzan and Jane.

Bono, in his role as Mrs. Jellyby in a 10-gallon hat, not only believes that he has the solution to Africa's ills, he is also shouting so loud that other people seem to trust his answers. He traveled in 2002 to Africa with former Treasury Secretary Paul O'Neill, urging debt forgiveness. He recently had lunch at the White House, where he expounded upon the "more money" platform and how African countries are uniquely futile.

But are they? Had Bono looked closely at Malawi he would have seen an earlier incarnation of his own Ireland. Both countries were characterized for centuries by famine, religious strife, infighting, unruly families, hubristic clan chiefs, malnutrition, failed crops, ancient orthodoxies, dental problems and fickle weather. Malawi had a similar sense of grievance, was also colonized by absentee British landlords and was priest-ridden, too.

Just a few years ago you couldn't buy condoms legally in Ireland, nor could you get a divorce, though (just like in Malawi) buckets of beer were easily available and unruly crapulosities a national curse. Ireland, that island of inaction, in Joyce's words, "the old sow that eats her farrow," was the Malawi of Europe, and for many identical reasons, its main export being immigrants.

It is a melancholy thought that it is easier for many Africans to travel to New York or London than to their own hinterlands. Much of northern Kenya is a no-go area; there is hardly a road to the town of Moyale, on the Ethiopian border, where I found only skinny camels and roving bandits. Western Zambia is off the map, southern Malawi is terra incognita, northern Mozambique is still a sea of land mines. But it is pretty easy to leave Africa. A recent World Bank study has confirmed that the emigration to the West of skilled people from small to medium-sized countries in Africa has been disastrous.

Africa has no real shortage of capable people - or even of money. The patronizing attention of donors has done violence to Africa's belief in itself, but even in the absence of responsible leadership, Africans themselves have proven how resilient they can be - something they never get credit for. Again, Ireland may be the model for an answer. After centuries of wishing themselves onto other countries, the Irish found that education, rational government, people staying put, and simple diligence could turn Ireland from an economic basket case into a prosperous nation. In a word - are you listening, Mr. Hewson? - the Irish have proved that there is something to be said for staying home.

Paul Theroux is the author of "Blinding Light" and of "Dark Star Safari: Overland from Cairo to Cape Town."

It's Gonna Blow

So, most of you heard the new threat to NYC's metro transit, or should I say the hoax. I don't know about ya'll, but I even received one of those emails...You know the kind..."My friend is friends with so and so who has a dad who works for what's that company? and he said Don't ride the subway for the next 2 weeks." Oh and pass this on to at least 10 people or you will be unlucky in love. Right? I mean please! Just don't ride the subway for 2 freakin' weeks? That's like saying "Just don't bother coming into work for the next week or so. No one will notice," -or- "Let's just park that chevy in the garage for awhile; no one really uses it anyway."

They must think we all own are own car in the city and just choose to use public transit, or that we can really afford to take a cab for the next 2 weeks. I might as well hire him as my personal chauffeur. If ya wanna boycott mass transit, think of a better way, and maybe one that is a little less "illegal." New York City's transit is already suffering enough. With the recent increase in metro fares, with another increase on the horizon, do you really think that mta could financially deal with a 2 week hiatus? Who are you kidding?

The thing that really makes me upset about the whole thing is that these "threats" are probably domestically generated. Like those boys who were caught placing a 'mysterious' substance in the subway as a prank that was thought to be a toxin of some fashion. If we cry wolf too many times, what will happen when the threat is real? It's so hard to take these things seriously anymore, and that is what is truly scary. We've crossed over from being prepared to being annoyed with the hastle.