Saturday, October 31, 2009

Reconsider the Proposed 'Census of Gay People'

Apparently Kenya is going to carry out a census of its gay population. People are expected to volunteer information about their own sexuality and the sexuality of others they believe to be gay. I certainly wouldn't volunteer information about my sexuality or that of others in Kenya. The issue of homosexuality is often met with a tight-lipped silence or a rabid stream of abuse.

The National Aids/STI Control Programme (NASCOP), which intends carrying out the census, claims that it is part of an effort to 'reach out' to the gay community. This may be so, but who will protect people's right to privacy when it comes to their sexuality? Will the police protect gay people or people suspected of being gay from persecution? This seems unlikely, given the police's reputation for being behind many kinds of persecution themselves. Police here are not known for their liberal views or even their love of peace and the rule of law.

All sexually active people should have access to HIV and other sexually transmitted infection (STI) testing facilities, condoms, sexual health education, counselling and other services. But they should also have the protection of the law and this is something that is not presently guaranteed. The way commercial sex workers (CSW), and those suspected of being CSWs or accused of being CSWs, are treated is a case in point.

NASCOP is worried that some people have the mistaken view that gay sex is safer than heterosexual sex, despite the fact that it is far more risky. But heterosexual anal sex is also mistakenly thought to be safer than vaginal sex. All sexually active people, and those who will soon become sexually active, need to know things like this. Men who have sex (MSM) with men may need additional services that other sexually active groups don't need. But groups who are at higher risk of contracting HIV and other STIs, such as MSM, CSWs and intravenous drug users, are all doing something currently against the law or considered to be against the law.

If the very act of trying to bring HIV and related services to gay people is also going to expose them to even greater dangers than they currently face, the whole idea of a 'census of gay people' should be reconsidered. It could be replaced by the provision of services to all people who require them, as and when. It may seem helpful to NASCOP to approach the gay population this way but there are too many flaws in getting people to identify themselves and others as gay in Kenya.


Wednesday, October 28, 2009

Prevention Needs to Consist of More than Good Intentions

To continue a theme that crops up regularly in this blog, an article on argues that Kenya needs to invest more in prevention campaigns than curative ones. True enough, but this article is about non-communicable conditions, such as hypertension, diabetes, mental illnesses, asthma and cancer. Health should start with prevention, whether that involves preventing communicable conditions, non-communicable conditions or even accidents such as road traffic accidents, industrial and agricultural accidents or injury and death from criminal acts.

However, realising that prevention is important is one thing, actually doing something about it is another. Take road traffic accidents (RTA), for example. All sorts of shenanigans have been put in place here recently, ostensibly to reduce RTAs. There are police checks and the rest, but what do the police do, exactly? Well, it's no mystery, they take a bribe and wave the driver on. There could be 22 people in a vehicle licensed for 14, bald tires, faulty brakes, out of date insurance or whatever, but as long as the police get their money, no further questions are asked.

In a country where health spending and health infrastructure has been reduced and continues to be reduced since the early 1980s, what exactly are health professionals supposed to do about all these conditions, communicable and non-communicable? The fact that prevention is better and cheaper than cure is irrelevant when there is bugger all money, anyway. But, even where prevention is even felt to be worth the effort, such as with HIV/Aids, are the figures for HIV transmission falling? Certainly not.

There is plenty of talk about preventing HIV but only 30% of HIV funding is allocated to HIV prevention. Most of that (which is probably nowhere near 30% of funding in reality) goes into a lot of mindless bullshit cobbled together by bigoted donors who don't give a damn about whether HIV transmission is really reduced as long as no one offends against their high minded but ultimately self serving interpretations of Christian morality. And it usually is Christian morality.

A report by a Nairobi based institution has come up with some alarming but unsurprising figures on teenagers knowledge of sex and their sexual behaviour. A large percentage of teenagers are having sex but they know little or nothing about safe sex. Unsurprising because they have been taught little or nothing about safe sex. Where has all the tens of millions of dollars intended for HIV prevention gone? It is has gone into not teaching teenagers about safe sex. I don't know how much money can be spent on the non achievement of something; that is in serious need of investigation. But the money is gone and the knowledge is nowhere to be found.

The report goes on to say that 40% of girls and 50% of boys have sex before the are 19, they believe all sorts of rubbish about sex, they fear pregnancy more than HIV, sex education is not taught in most schools, contraception is usually not mentioned (for fear of horrifying donors, politicians and church leaders, who are very sensitive people), half of the girls in a survey had exchanged sex for money, gifts or cash and 47% of the teenagers surveyed either had a child, were pregnant or had undergone an abortion. A separate study finds that 5.5 million girls between 15 and 19 give birth annually in Kenya, that's one eighth of the entire population!

If the calls for investment in preventing disease were to lead to improvements in very basic goods, such as water, sanitation and infrastructure, basic living conditions, primary health, education, gender equality, legal reform and things like that, Kenya would eventually be a lot better off. But it seems more likely that if any money is provided to prevent diseases and improve health, it will be spent on following purely political, commercial and religious agenda. Once those have been attended to, there's rarely any money left for anything else.


Tuesday, October 27, 2009

Funding Health is Cheaper than Paying for Disease

To continue a theme I hit on in my last post, Reuters AlertNet lists lower respiratory infections as the top killer, accounting for more than 4 million deaths in developing countries. HIV/Aids is listed as number two, accounting for three million deaths, although serious under-reporting of HIV deaths must place a question mark over whether HIV/Aids is really number two or number one.

But the number three killer is interesting because malaria is said to be responsible for between one and five million deaths every year. Added to this, diarrhoea, at number four, kills an estimated 2.2 million people every year. So if deaths caused by poor water and sanitation were added up, they could easily be a contender for 'top killer'. are excited at the possibility that diarrhoea may now get as much attention and funding as HIV/Aids. But funding and attention for a specific condition is missing the point. The number of people suffering and dying from diarrhoea is dwarfed by the number who suffer and die from water borne conditions and others that result from lack of decent standards of water and sanitation.

Health is not merely a matter of curing sickness; it is primarily a matter of ensuring that people live in circumstances that will maximise their health. In other words, they need a decent standard of living. Treatment and immunisation are great but they are no substitute for prevention. A lot of disease and death could be much more cheaply prevented by providing people with good water and sanitation.

Similarly, many of the lower respiratory infections that are said to comprise the top killer result from poor living and working conditions. Added together, water borne diseases and lower respiratory infections probably outnumber all other killer diseases in prevalence and mortality. So the effect of improving living and working conditions combined with improving water and sanitation would be profound.

But a health strategy that effectively consists of targeting diseases, or even risk factors, and starting with the biggest, seems to miss the reasons why so many people suffer and die unnecessarily. There isn't a need to target diarrhoea, for example, because it kills more children than HIV/Aids. There is a need to provide people with a standard of living that enables them to avoid all water borne diseases. Lower respiratory infections may be the top killer but simply vaccinating everyone and treating everyone infected will still leave people living in poor conditions.

To use a different example, malaria prevention is not just a matter of distributing bed nets. If you continue to ignore the festering pools of water that you find everywhere, your children will still go out and play in or near them when they wake up. Festering pools of water are not conducive to good overall health. The bed nets are vital in some areas but the risk of both malaria and other water borne diseases can be lowered by an improvement in sanitation and hygiene conditions.

Luckily, the WHO recommendations to which the AllAfrica article refers includes improvements in water and sanitation. But it remains to be seen if the World Bank and the International Monetary Fund (IMF) keep in step with the WHO. Since the early 1980s, these institutions have worked to reduce health, education and infrastructure in developing countries. They have concentrated on dismantling the structures which allow people to live healthy lives.

There's a sense in which health policy and funding seem to concentrate on downstream effects, particular diseases and health conditions, rather than on the upstream determinants of health.


Friday, October 23, 2009

Towards a Vaccine for Stupidity?

In an article entitled 'HIV vaccine trial results raise more questions', the recent, much reported vaccine trial results are, it is suggested, open to many interpretations. But whether a HIV vaccine is still a distant hope or already close at hand, I would argue, is not what we should be concentrating on.

Some of the reasons why many people are becoming infected with HIV and other sexually transmitted infections could be that they do not have access to good sex education or family planning, they do not use condoms, they are not always in a position to choose whether to have sex, when, with whom, how often and under what circumstances. True, many people know that HIV is a threat but there are so many threats that people just get on with their lives, HIV positive or otherwise. But this only partly explains high HIV prevalence.

Health, education and other social services are pretty much inaccessible to the majority of Kenyans and the majority of people in all developing countries. People are, effectively, denied their rights to a decent standard of living. They live in poverty and suffer from the consequences of poverty. People experience all manner of illnesses that are easily and cheaply controlled and many die unnecessarily, often at a very young age.

HIV is just one of numerous diseases that threatens the lives of people in developing countries, just one chronic disease that further impoverishes people who are already impoverished. The fact that billions of dollars are spent on finding HIV vaccines and other drugs does not make people more scared of it. Sometimes it even makes people think that a vaccine or cure is probably just around the corner.

Cures and vaccines are likely to be some way off; affordable cures and vaccines are quite another story. But, as we have seen over a period of more than two decades, people certainly don't modify their behaviour in the way that health and other professionals suggest they should. This is as true of developed countries as it is of developing countries, as true of HIV as it is of obesity, dangerous driving, drinking, various kinds of exploitation, corruption, crime and drug use.

What should we be concentrating on? Instead of putting such copious amounts of HIV funding into treating people already infected, a lot more money and effort needs to be put into preventing new infections from occurring. Much of the money currently spent on treatment and care of HIV positive people goes into intellectual property. In other words, there is existing legislation that would allow the costs to be cut, substantially, without reducing current levels of treatment and care.

As to what measures could lead to preventing HIV infections, a lot of research is needed, research that must be carried out without the biases of power politics, pseudo moral posturing, fashion and pure greed. By now, we know a lot about what doesn't work and we need to be frank in admitting that. But perhaps we also have some insights now; perhaps the promise of greater lifetime opportunities could lead to people taking fewer risks and making better decisions that relate to their health. The promise of a better standard of living, education, employment, habitation, health and social services could achieve a lot more than the patronising rubbish that has, up to now, passed as HIV prevention programming.

Most people in the world live in poverty and are denied their basic rights. They live in the majority world. Rather than putting so much of the world's aid money into a cure for one disease, some of this money could be used to change the way the minority world treats the majority of people. Indeed, much 'aid money' is used for all sorts of things aside from aid. It's used for 'technical assistance' (which usually means paying rich Western consultants and experts a little too handsomely for their advice), dumping surpluses, subsidizing the industries of rich countries, creating markets for consumer goods, etc.

Kenya and other countries not far from here are used and have long been used, as sources of cheap raw materials and labour. Much of the country's land and resources are given over to producing raw materials for the minority world. Much of its workforce receives very low pay, working in conditions that would be illegal in the West, to produce raw materials and cheap goods for the West.

Like all other diseases, HIV has a context, an environment. Countries with high HIV prevalence also have high rates of other diseases and other health and social problems. They suffer from extreme levels of deprivation and they are usually heavily exploited by rich and powerful countries. While a vaccine or cure for HIV may be a long way off, vaccines and cures for other diseases are not just available but cheap, for example treatment for intestinal parasites, which affect billions of people.

Some of the biggest killers are things like water borne diseases and acute respiratory conditions. Perhaps as much as half of the illnesses and premature deaths in developing countries could be avoided by provision of clean water and sanitation and decent places to live. That is not beyond human ingenuity, it just doesn't seem to get the same attention as a possible vaccine for one disease that affects far fewer people.


In a recent posting I argued that "it is not poor people in developing countries who contribute the most to global warming and environmental destruction, it is rich people in rich countries." A friend complemented me on this argument but I had to admit that it comes from an article entitled 'The Population Myth', by George Monbiot. Indeed, many of my views on development are influenced by the writings of Dr Monbiot and it was not my intention to claim credit for his work.


Wednesday, October 21, 2009

People Need Protection from Harm, Not Punishment for Being Harmed

It has been revealed at a conference in Nairobi that 60% of all new sexually transmitted infections, including HIV, occur in those aged 15-24. These are the very people who should have received, and should still be receiving in the case of those in their mid teens, the latest HIV prevention programming. The authors of the report even suggest that there may be significant under-reporting of risky sexual behaviour.

The report calls for a 'more aggressive' educational approach, whatever that may mean. In a separate article on back street abortions in Kenya, there are some worrying remarks on sex education. Aside from concentrating on abstinence, often to the exclusion of anything else, teachers who are trained in teaching sex education are under no obligation to teach it. There is no specific time set aside for them to do so and many parents would prefer teachers not to teach their children anything about sex.

Kenya has spent over 20 years resisting the call to teach their children and adults about sex, safe sex, family planning, maternal health and health in general. In particular, they have resisted advice to promote the use of condoms to prevent HIV, other sexually transmitted infections and unplanned pregnancies. The multiple uses of condoms need to be stressed.

The repeated calls for abstinence, however dressed up in pointless slogans, are useless. Years of sexual transmission of HIV, other sexually transmitted infections and unplanned pregnancies show that these 'prevention' programmes have not worked. Unfortunately, the latest National Aids Strategic Plan has little new to suggest to prevent HIV from being transmitted and it still only allocates about 30% of HIV/Aids funding to prevention. But no amount of money will make a difference if abstinence is the best they can come up with.

Countries with high rates of HIV transmission seem to be obsessed with abstinence campaigns, which have had no impact and will continue to have no impact. Telling young people that it is worth their while waiting till they are married is simply lying in the face of evidence that many people become infected by their spouse. They need to be told about the dangers they face and given ways to avoid those dangers. If condom use is the best we've got right now, we owe it to people to promote the use of condoms.

Those who object to abortion, HIV, sexually transmitted infections, promiscuous sex, unsafe sex, sexual abuse and various other things that they rail about need to embrace comprehensive sex education for everyone, young and old. Denying the existence of risky practices, commercial sex work, men having sex with men, intravenous drug use and the rest is not going to make it go away. Moralising about it and saying how bad it all is will not make it go away either.

It's very hard to legislate over people's sexual behaviour. And even behaviour that is illegal will occur, despite the threat of punishment. The least the Kenyan government can do is to reduce the amount of harm people are currently being exposed to. Many Kenyans are now experiencing the consequences of not implementing harm reduction programmes, such as the widespread promotion of condoms, decriminalisation of commercial sex work and same sex relationships, needle exchange programmes and even family planning services that would support people who end up pregnant against their wishes. People need to be protected from harm, not punished for being harmed.


Tuesday, October 20, 2009

Will We Prevent the Next Genocide?

The land grabbing orgy currently taking place in developing countries is a lot more serious than I thought. There are some countries buying up or leasing land but the biggest buyers are actually corporations. Corporations have amply demonstrated in the past that they don't care anything for the lives or livelihoods of people, they only care about maximizing profits for their shareholders and other interested parties.

In addition to grabbing land and denying millions of subsistence farmers their only means of survival, this trend is part of what has been driving up the price of food, especially staple foods. These corporations can also indulge in some practices that would be more difficult or expensive or perhaps even totally illegal in other countries. For example, land in developing countries is seen as ideal for biofuel crops. It's also seen as a good place to grow genetically modified crops that have not been given the go ahead in other countries.

Everyone feels the effects of rising food prices, of course. But for people who were barely able to afford enough food to eat a couple of years ago, the rush to buy up or otherwise occupy land in developing countries will push many people well below the threshold of having enough food, however lacking in nutritional value, just to survive.

Developing countries are also presently experiencing severe water shortages. Rich countries growing their food in developing countries means that they are effectively exporting huge quantities of water from those who have least to those who have most.

Corporate nobs may talk of 'win-win' situations, or even 'solving world hunger' but it is only people who are now rich who have any chance of winning anything and those who are now poor who face starvation. There is nothing in this for development, it is purely motivated by the need to make big profits. In addition, land and water supplies will be contaminated by the large scale agricultural practices which are absolutely necessary for this sort of investment to be really profitable.

I realise that those driven purely by profit are not going to be interested in these questions: but what will people now on the brink of starvation do once they have been thrown off their land? And what will those now barely able to afford basic foods do when the price has gone just that little bit too high? What will the rest of the world do when most of the land and water that have been supplying them with food are contaminated to the extent that they are no longer productive?


Sunday, October 18, 2009

Rich Academics Talk Bollex About Climate Change

Academics and wannabe academics have been beating on for decades about population growth being a threat to humanity. The main paradigm for development was, for many years, population control. Extremely well funded organisations from rich countries went around developing countries trying to persuade people to adopt various birth control techniques and technologies, whether they wanted to or not.

Most of these organisation in most of the countries where they worked were not very successful. In Kenya, when the British finally left, health, education, water and sanitation, infrastructure and other social services started to improve from the 1960s to the end of the 1970s. At around the same time, fertility also started to drop.

However, development came to mean economic development as the World Bank and International Monetary Fund (IMF) began to, effectively, run most developing countries. All the things that had started to improve went into decline and are still declining today, nearly three decades later.

Also in the late 1970s and early 1980s, HIV started to spread rapidly. Once it was identified as a sexually transmitted virus, the same organisations that had been toting condoms and contraception as a panacea for development changed their tack and tried to promote the use of condoms to protect against HIV and other sexually transmitted infections. These efforts have been even less successful than their earlier efforts.

Now, the 'Optimum Population Trust', run by a collection of academics and wannabe academics, is advocating the use of condoms to curb population growth as a means of reducing climate change due to over consumption. They are suggesting that this is the most economic method of influencing climate change, too, cleverly combining those two earlier development paradigms into one.

Ironically, when people have smaller families, they often become bigger consumers. In fact, many people say they want to have smaller families so they can afford things like cars, consumer durables and various other goods. So, the result of reducing family size is often an increase in consumption. In fact, there is little connection between high fertility and high consumption. On the contrary, populations with high fertility rates usually have low rates of consumption. The biggest consumers have low fertility rates.

In Kenya, much of their carbon emissions result from the production of goods destined for rich, high consumption countries. Kenya produces all sorts of goods in Export Processing Zones (a posh name for sweat shops), fruit and vegetables are force grown under electric lights and transported by air and biofuel crops that are responsible for the destruction of much of the country's remaining land resources. The rich have managed to export a lot of their carbon emissions to developing countries.

Contraception is a vital technology in reducing the spread of HIV and other sexually transmitted diseases. It also reduces unintended pregnancies. And many of the children who are born to HIV positive women are, in fact, unintended. There is a huge unmet need for contraception that the birth control evangelists seem to have done little to alleviate over the course of the last half century.

But it is not poor people in developing countries who contribute the most to global warming and environmental destruction, it is rich people in rich countries. Fertility may be low in rich countries, thankfully. But that doesn't reduce consumption, rather, it seems to be behind much of the continued increase in consumption.

Apparently this Trust is very excited by a study based on the principle that "fewer people will emit fewer tonnes of carbon dioxide". But this principle is flawed. Lower consumption (or fewer high consumers) will result in fewer tonnes of carbon dioxide. Most people in the world are low consumers. Here in Nakuru, some of the poorest are probably even negative consumers. The municipal dump is full of homeless people who derive their meager income by collecting and selling rubbish for recycling. Some even live in the dump in hovels made from waste.

I'm not suggesting that it is a good thing that people live like that because it isn't. What is disgusting is the idea that very rich, well educated, well fed people are pointing the finger at the very poorest of people and saying that they are the problem when it comes to climate change and environmental degradation.

So Porritt, Attenborough, Lovelock and other pompous tossers, leave your comfortable homes and offices, visit a few poor countries, or even poor people in your own countries, shut your big gobs, open your eyes and then rethink the consequences of the cooperation of a mere handful of the world's biggest consumers for the whole of humanity. Those who are condemned to a life of poverty will reduce the size of their families when they can see that it will be of direct benefit to them and people like them, but certainly not to people like you.

[See George Monbiot's 'The Population Myth' for an elaboration of the above argument.]


Saturday, October 17, 2009

Homosexuality: Uganda Scores Another Own Goal

Uganda is busy going the wrong way again in their 'fight' against Aids. Parliament will discuss a bill to create even more offences that gay people can commit. It's already an offence to have a sexual relationship with someone of the same gender. The 'offence' will carry a seven year sentence, as will aiding, abetting, counselling or procuring another to engage in acts of homosexuality.

HIV/Aids and sexual rights activists feel this sort of law will make HIV prevention, treatment and care services even less accessible that they currently are. No one is going to admit to being gay or to risk being exposed as being gay even under current circumstances. No one wants to be stigmatized or discriminated against, however unfairly.

There is even a proposed death penalty for sexual assault against someone of the same gender who is under 18 or disabled. But sexual assault against anyone should always be against the law, as should sexual assault against someone who is below the age of consent, male or female, same sex or otherwise. Ugandan law considers sex between people of the same gender to be against the laws of nature. If anything is against the laws of nature, it is for a homosexual to have heterosexual sex. But what law is homosexual sex supposed to be breaking? Are these laws written down? I don't think so.

Ugandan laws would be better off protecting vulnerable people, especially children, improving the status of women, targeting those who are most at risk and removing barriers to prevention, treatment and care services instead of creating new laws that make those services less accessible. The law could also give a bit of attention to reining in the power of leaders who appear to have gone crazy. And reducing the number of people who live in extreme poverty would also be a good thing.

Sex itself is neither moral nor immoral. There is no moral argument that shows that homosexual sex is immoral, only an arbitrary judgment. Punishing people for behaviour that is not immoral and creating laws to legitimise this punishment, that is immoral. The law in Uganda is being misused to serve the interests of those who make arbitrary judgments about morality. Stigmatizing and discriminating against people, which supporters of this bill are doing, is immoral and should also be punishable by law.


Thursday, October 15, 2009

Al Gore's Bullshit Won't Make the Crops Grow

Today is Blog Action Day, where lots of blogs around the world all write about some aspect of climate change. I'm all for promoting environmental and climate change issues but I noticed that, pretty late in the day, Al Gore got involved in the initiative. I'm sorry that an otherwise worthwhile sounding effort feels the need to be associated with a loudmouthed freeloader who jumped on the environmental bandwaggon when his political career went off the rails. I suppose there'll always be Gores and the like, who attach themselves to something that allows them to promote their own interests.

Anyhow, developing countries like Kenya are going to bear the brunt of climate change and are probably already feeling the effects. There have been prolonged droughts in many areas for some time now. The El Nino rains are due to start soon, which may resolve some of the short term problems. But they may also increase the problems. If the rains are too heavy and result in flooding, crops that are planted could be washed away. There has already been flooding in several areas, with loss of life and livelihoods and a lot of people being displaced.

The Kenyan government has done little to alleviate the problems and probably a lot to exacerbate them. The much talked about Mau Forest, where large scale logging over a long period has probably resulted in a massive reduction in water tables, is still being destroyed. True, the government has very publicly evicted small settlers in the forest but they will not quickly reverse a problem that took such a long time to develop.

Over several decades, people have been persuaded to grow things for export, such as flowers, tea, coffee, fruit and vegetables. This sort of farming has done a lot of environmental damage. But also, these are cash crops and they are not used to benefit ordinary Kenyans. They will not solve the food shortages because they are produced by rich landowners, often foreigners, who expect big profits.

What Kenya needs now, and what they have always needed, is food security. They need to produce enough staple crops for the domestic market and ignore the advice they seem to get from foreign interests to keep concentrating on exports. Feeding Kenyans should be the priority.

The Kenyan government is belatedly talking about things like providing fertilizer at low cost. This may help some large scale farmers but it is unlikely to help small farmers, the majority, who only produce enough to provide for themselves and perhaps for a modest surplus. Some of them are planting right now in the expectation that rains will come. If the rains come, great. But if there is not enough rain, the crops will be destroyed by the use of these artificial fertilizers, just as much as they would be if the rain failed altogether.

This kind of intervention is typical of the sort of short term thinking that has made small farmers increasingly vulnerable as the years go by. Small farmers need also to consider organic waste, household and farm waste, whatever is available. Artificial fertilizers may be of use in the short term, especially to large farmers, but even they eventually end up destroying their land.

But small farmers can least afford this process of land degradation. To keep their costs and their losses low, they need to use cheap or free materials. Because, even if they don't have to pay much now for artificial fertilizers, they will still have to bear the costs in the long run. The production and use of artificial fertilizers is part of the problem, it will never be a sustainable solution. It may not even be a short term solution.


Wednesday, October 14, 2009

Born Obsolescent But Still Around, Unfortunately

Apparently a report has found that the IMFs (International Monetary Fund) fiscal and monetary policies have stifled Kenya's fight against HIV and TB. They concluded that restricting government spending on health resulted in poor health outcomes.

That's not just a conclusion, that's almost a tautology. Poor healthcare always, everywhere, gives rise to poor health outcomes. I applaud the report writers but I wonder what influence their findings and recommendations will have in the secretive and atavistic 'Bretton Woods' institutions. The report even found that HIV/Aids work is now almost totally dependent on donor funding.

Virtually anyone who has studied HIV, its spread and the almost total (but extremely expensive) failure to reduce its spread, would have, and probably have, come to the same conclusions. But what effect has research ever had on the way the IMF does its work?

The report also concludes that the IMF's policies are partly to blame for Kenya's poor economic performance. But this is true of the economic performance of every country that the IMF has interfered in. In the whole history of the IMF, they do not have one single success story. They beat on about reform, democracy and accountability. Yet they have never been reformed, they are not in the least bit democratic and they are not accountable to anyone.

It's odd that both the World Bank and the IMF can produce reports that, at the same time, boast of the great things that they have done and also admit the failures that, essentially, are the great things they have done. Anyhow, the full report is available, but keep a sick bag handy.


Tuesday, October 13, 2009

Displaced by Violence; Resettled by Violence

Many of the Kenyans who ended up in camps for internally displaced persons (IDP) are there because they supported or are seen to have supported Mwai Kibaki, the current president. However, Kibaki feels that it is intolerable that people should still be in IDP camps and so he announced a few weeks ago that they were all going to be resettled elsewhere.

Most people tried to stay where they were until they were sure the government was really going to pay them the pittance they are getting for resettlement, about 350 dollars. But they were told they would not get the money until they dismantled the temporary accommodation they have been living in for nearly two years. The amount of money they have been given will not buy them much, certainly not land. But some promises have been made about land, too.

Whether these promises will be kept and to how many people is not clear and may never be clear. But press coverage of IDP resettlements seem to be confined to the very discreet and peaceful events at the ironically named Eldoret Show Grounds. I don't know if the press was selective in what they covered but Kenyan TV coverage today included extremely violent 'resettlements' with riot police beating people with truncheons and firing tear gas on displaced people currently living in camps.

Recent coverage on the BBC claims there will be 'no forcible evictions', but today's events seem to contradict that claim. You can go around from village to village here in the Rift Valley and see the remains of houses and other buildings that have been raised to the ground, often burned down. Why would people who were displaced so violently return to the neighbours who tried and even succeeded in killing and maiming so many of them?

The government's response does not see reasonable, so I hope press coverage takes as much interest in the 'resettlement' programmes as they did in the original violence.


Monday, October 12, 2009

Distance No Object, We Just Don't Go There

The majority of HIV positive people in Kenya live in rural areas. Granted, the percentage of people who are HIV positive in urban areas is higher than the percentage in rural areas. But most people, perhaps as many as 80%, live in rural areas.

So why are most big NGOs, including ones who are mainly concerned with HIV, based in urban areas? In fact, most health facilities, social services, government offices and just about anything else you can think of are based in urban or semi-urban areas.

Here's an example of the ridiculousness of this phenomenon: Nairobi, the capital city, is high up and therefore not very hot. There are mosquitoes there, aplenty, but malaria is not very common. The climate is just not right for the malaria bearing mosquitoes, though there is plenty of stagnant water around to support huge colonies of insects and other disease vectors.

Yet, the highest rate of mosquito net ownership is also in Nairobi. Could this be connected to the centralization of health, social services and various benefits and amenities in the capital? It's hard to tell, but it's certainly a bizarre situation. Many, perhaps most, of the mosquito nets in this country are donated by NGOs. How do so many of them end up getting stuck in the areas where they are least needed?

Nakuru is not huge, by any means. But as it's only a few hours from the capital and has its own academic institutions, it also has many academic and social projects. There are numerous NGOs doing all sorts of things here. It has far more visible street children than the much bigger capital city but it is not the most neglected of areas, either.

But travel an hour (or less if you have your own transport) out of town and you will come across villages where people rarely see NGOs or receive any of their largess. And in these villages, there are people needlessly suffering. They have the same problems as people in villages and towns closer to the privileged areas but they do not have the means to reach those areas.

Today we saw a boy whose face is terribly disfigured from burns he received several years ago. His burns were not treated in time. When they were treated, they were not treated properly. After spending over one and half years in hospital, he now has one eye, which may also be under threat, his nose is disfigured and threatened, his mouth is deformed and, most alarmingly, his skull was fractured as a result of the medical treatment he received, the medical treatment which seems not have worked yet. And the treatment cost about the equivalent of seven years salary.

There are HIV positive people who can't afford the transport to get tested, because the testing centres are in the towns and cities. There are those who know they are HIV positive but who can't afford the transport or the costs that need to be met before they can receive the, admittedly free, antiretroviral treatment (ART). There are people who need cheap drugs and treatment that they will not receive because they are in isolated areas. Many have died because of their isolation and many more will die for the same reasons.

Even the organisation I was supposed to work for is based in Nairobi. Why? I have no idea. They have no projects there. They do have five road worthy vehicles and eight motor bikes. Why? I have no idea. I don't know when any of them last visited Nakuru. I don't think any of them in head office have ever visited the village we were in today, nor would they even have heard of it. Why? I have no idea. They don't respond to my emails and I am supposed to be working for them.


Saturday, October 10, 2009

Self Reliance Doesn’t Protect Against Unreliable Leaders

We have built a bigger parabolic cooker and are now waiting for a suitably sunny day to try it out. Some areas around here get sun all the time but the parabolic cooker is not very mobile. So we just have to wait for suitable conditions. Meantime, one of the things we are concerned about is safety. For a start, the concentrated light reflected from the device is very hard on the eyes and could potentially damage users' eyesight. We can use sunglasses but there's no guarantee that others will do the same, especially as some of the people around will not even be using the device but could still be affected.

There is also the issue of safety from burns. Parabolics heat things to very high temperatures. Some of the models I've found online depict a cooking pot at about chest height. If this pot were to be turned over by accident, the user could receive dangerous burns. I would prefer a model where the pot is low and where you can move the parabola without moving the pot and vice versa. This should reduce the possible dangers. We discussed this problem with other people experimenting with parabolic cookers and they agreed. We resolved to suspend the pot from a line or large tripod, rather than trying to build a tripod inside the parabola.

One of the community support groups is so interested in solar cooking that they have asked for a workshop on making the cookers. We will be doing that in the next few weeks, once we have all the materials. The members of the support groups themselves need to bring the materials because there is very little funding available. But it is a good exercise to get them to source the materials as most of them should be cheap or even free. One of the advantages of solar cooking is increased sustainability and self reliance. Therefore, recycled materials are preferable to new materials. I suspect people here will be good at finding cheap and free materials!

The same people who have shown such interest in solar cookers also raised questions about home made, reusable sanitary pads. A friend kindly sent me some materials on how to make these. I also found various websites dedicated to this issue. Sanitary pads are so expensive here, compared to people's ability to buy them, that it is no wonder many never use them. This is a particular problem for young girls as they have no spending power at all. They often miss school for a few days every month, which is quite unnecessary. However, there are safety aspects relating to making reusable sanitary pads as well and I hope we can include resolutions to this problem as part of the project.

We're still trying to find out about getting people to produce briquettes from organic waste as a way of reducing use of wood and charcoal, which is expensive and in short supply. It's also time consuming to collect wood and make charcoal. We have plenty of instructions for the process but lack the devices that could mix the materials and compress the mixture into a suitably compact end product. We are in touch with people at Egerton University who may be able to help us. Ultimately, the process should be cheap and small scale, but as someone near here has already done some work on this area, we'd like to see that first.

We visited the local municipal dump to see what useful materials may be available there. Actually, there are many people in the dump, every day, picking up all the materials they can sell on for reuse. I think we need to spend more time finding out what reaches the dump, who is picking it up and selling it on, what materials never reaches the dump and what other recycling projects are currently taking place. There are lots of organisations here doing various things and few organisations seem to be aware of what others are doing. As we are trying to find tried and tested ways of reducing poverty and increasing self reliance, we need to know what others are doing in and around Nakuru. That is proving to be a difficult task!

There's a lot of talk about closing down the camps for internally displaced persons (IDP) which were set up as a result of the post election violence. It's all very well to get people to go back home but many don't wish to return to properties from which they were forcibly ejected. Many of the properties have been burned, looted and squatted by others. The government is giving many mixed messages about how much they will pay people to return home and what they will do for people who can't go back to where they were before. Also, the IDP camp in Nakuru consists of many small plots, all of which have been purchased by the residents. People have been there for nearly two years, they have made lives for themselves. They have set up kitchen gardens, shops, community groups and what not. The 'camp' is now a village in its own right and the current government plans seem like yet another forced eviction.

The support group that we are involved in at the IDP camp is interested in some of our projects and this area is in particular need of greater sustainability and self reliance. But people there are now wary of doing anything in an area that they may have to leave in the near future. There is even talk now about the next election and the possible displacement that may occur in the next few years. Far from trying to anticipate and prevent further politically motivated violence, politicians seem to be spending their time and energy planning their attack.


Friday, October 9, 2009

Headline Grabbers and Land Grabbers

It's been a couple of years now since Bob Geldof made his injudicious pronouncements about biofuels. He should have known better and given the matter some thought. A little research wouldn't have done any harm either. Scepticism about biofuels didn't just appear recently. The environmentalist George Monbiot argued very cogently against biofuels nearly five years ago and has written many more articles on the subject since then.

But now the issue of land grabbing is being discussed more frequently and the part that biofuel production plays in land grabbing is clearly significant. Many of the claims about biofuel crops, such as jatropha, being productive even in marginal lands, turns out to be lies. Biofuel crops can be either non-food crops or food crops that are just not being used for human consumption but they all need good land and good growing conditions. So in the Tana River basin in the East of Kenya, sugar is being grown on an industrial scale in an area of great ecological importance while millions in the country starve. There is even a shortage of sugar in some areas!

Food prices have been rising for some time but producers of biofuels refuse to accept any responsibility for this trend. Good land is also in short supply here and in other developing countries. And many areas are facing drought, so growing crops that are subsequently used for biofuel production means the country is effectively exporting much of its scarce water supplies as well. It's not even as if poor Kenyans are benefiting from this, either. Many small farmers are displaced by the biofuel growers, who are all large-scale operators or connected with large-scale operators. They use factory scale production methods that require very few employees. People who formerly owned or farmed the grabbed land have either been bought off for a pittance or squeezed out some other way.

Governments of developing countries usually connive with the various multinationals and rich countries who are looking for cheap land. They are of little help when it comes to protecting ecologically important areas from being destroyed. And they seem happy to allow overuse of destructive artificial fertilizers as long as that gives big landowners and users increased crops, at least temporarily.

This land is also being destroyed because biodiversity is wiped out by large scale production. In the near future this land will simply be useless. If biofuels don't take off, the areas will probably be abandoned, as some operations already have been. And even when these multinationals and other parties use the huge tracts of land they 'purchase' for food production, it is produced for export, with bugger all in taxes or wages or anything else going to the developing countries. It's hard to estimate the numbers of people who have been displaced, dispossessed and otherwise abused by land grabbing, biofuel production and food production that is exclusively produced for export to rich countries.

Most farmers in developing countries are small farmers. They have never made a decent living from contributing small amounts of cash crops to big operators, and they never will. They need to concentrate on producing food for themselves, their families and the local market. People such as Geldof, with little or no knowledge of the conditions under which people in developing countries live, should do some research. The man has tens of millions of dollars, he could even afford to pay someone to do the research for him. I hope in the future he will admit his mistake and campaign against land grabbing in all its forms and especially against biofuel production.

Geldof and other 'philanthropists' may well boast about all the money they have raised for the developing world but they seem to have little idea of how much is being extracted from these countries. The money they claim to raise is puny compared to the amounts of money being extracted by food companies, biofuel producers, mining operations, pharmaceutical companies, healthcare companies, textile companies, sweat shops (or whatever they are now called) and just about any multinational you can name.

Instead of ranting on about things they don't understand, these people could try concentrating on some of the areas where vast amounts of wealth are stolen from developing countries by multinationals, rich governments and even some of the very people who think of themselves as philanthropists. It's time for some development by omission: development through reducing the exploitation of developing countries by the rich.


Wednesday, October 7, 2009

Empty Pockets Revisited

It's nice to be able to try out some of the things I've been looking for, thinking about and researching for a long time. Not my ideas, by the way, just ideas that sound like good income generation activities and ways of saving money. Generally, they are cheap or free sustainable activities that are easy to get involved in, even for those who have few practical skills, such as myself. I'm harking back to a posting entitled 'Empty Pocket Finances', which I wrote nearly a year ago.

The sort of projects I am thinking of have not changed that much. At present we are trying out solar cookers and cooking baskets but we would like to look into reusable, home-made sanitary towels, briquettes made from organic waste, solar fruit and vegetable driers and, I'm sure, many other techniques. Anything that people can fit into their day to day life with the minimum bother and the maximum benefit.

In addition to persuading people to use solar cookers, cooking baskets, home-made sanitary towels and other things, we would like to get people to make these cookers, baskets and towels themselves. Perhaps they'll even go on to teach other people and convert them to the virtues of sustainability and self-reliance. Then it will be up to them to sell the ideas on to others. So, in addition to saving people money, some people should be able to go on to make money. Admittedly, just a little money, but some of our clients are making almost nothing right now.

So much for the theory, anyhow. But we visited a Ministry of Agriculture office that has been involved in developing appropriate technology for several decades, apparently. One of the people we talked to had little good news to impart. He said he had long been trying to persuade people to do things that would be of benefit to them, with very little success. On the other hand, his colleague seemed to be of the opinion that people find change hard but that that's no reason not to continue to develop good ideas and try to disseminate them.

We also visited Egerton University to see a parabolic style solar cooker being constructed using an umbrella, much like the one I made recently, only bigger. I want to try a bigger one now to see if they can do some things that the Cookit can't do. I'm pretty sure they can but I am worried about safety aspects as people here are not exactly safety conscious. For instance, parabolic reflectors can quickly damage your sight. And if they heat things up to high temperatures, they are potentially dangerous when it comes to spillages, especially when children are involved.

But maybe this won't be a problem. When we were at Egerton, we were able to make some design suggestions that should make the parabolic cooker a lot safer. As for the difficulty of getting people to adopt new things, we hope that living close to our clients will mean we can check up on and badger them regularly. And if they tell us they are short of money or that they need something, we can ask them why they haven't adopted the wonderful techniques that various people around the world have made available, free of charge.


Tuesday, October 6, 2009

What Has Solar Cooking Got to do with HIV Prevention?

Another day courting the sunshine. I decided to try to cook githeri, a mixture of maize and beans. But it takes a very long time and after four hours of demonstrating and discussing solar cooking, I took the mixture home to finish cooking it on a jiko (charcoal cooker). However, the rice and vegetables were evidence enough to convince the group of about 15 people. So we'll get together again next week and discuss the issue further. The following week, we'll have a workshop to make our own solar cookers. The week after, who knows...

This blog started off concentrating on HIV and it may seem that I have wandered off the point. But let me recap a bit. Throughout, I have argued that HIV transmission is related to many of the everyday aspects of people's lives, such as their environments, their employment status and work conditions, their levels of income and education, their health, nutrition, sanitation, infrastructure and many other things.

Solar cooking, solar water pasteurization and renewable energy sources in general have the attraction of addressing many of these issues. Using renewable energy means that people use less wood, which is great news for the environment. They produce less smoke and greenhouse gases, which reduces sicknesses related to smoke inhalation. Acute respiratory infections (ARI) represent one of the biggest threats to people's health and life expectancy. ARIs combined with diarrheal conditions account for around 40% of deaths in infants and under fives.

Paying for fuel is a major day to day cost that can be cut by using something like solar energy, which is very plentiful in African countries. Much time and energy is spent on collecting and preparing fuel for cooking, time that could be better spent doing other things. And there are few better ways for people to increase their self reliance than to explore renewable and sustainable resources.

Food cooked on solar cookers cooks slowly and is therefore more nutritious. It also uses less water, something that is in short supply and that can take a lot of time and effort to collect. In fact, the job of collecting fuel and water often falls to women and children, especially girls. Many's the time children don't do their homework because they spend the remaining daylight hours after school doing household chores.

At the moment, we are concentrating on telling people about solar cookers, why they could make their lives easier and better, how it could help them save money, etc. But in the longer term we are looking for income generating activities (IGA). For example, it's possible to make items to sell, such as cakes, roasted peanuts, ugali (boiled maize meal) and other popular foods, commonly sold on the street. Saving on fuel costs could give people the edge over their competitors. Perhaps people could also make and sell solar devices such as cookers and cooking baskets.

Well, that's why we're experimenting with solar cookers and those are some of the reasons we feel they are relevant to HIV and HIV prevention.


Monday, October 5, 2009

Donor Funding: Pseudo Worries About Pseudo Aid?

The parabolic solar cooker, made from an umbrella lined with tinfoil, works well when it comes to heating up water. I'll try cooking with it when I have found a suitable pot with handles and painted it black. Meantime, I wish to demonstrate the 'Cookits' that I bought from Solar Cookers International to an audience that could turn out to be as many as 20 people, far from ideal. I'd prefer very small groups of people but I've agreed to it.

As I am trying to win people over to solar cooking, I'm concentrating on things that people here like to eat. Thankfully, that's quite a small range of fairly basic foods. Tomorrow I hope to cook githeri, a mixture of beans and maize. It will take some time to cook so I'm hoping for 4 or 5 hours of uninterrupted sunshine. I'll have to cook something else that doesn't take so long or my credibility could be open to question.

Actually, the credibility of some Westerner lecturing people in a developing country about renewable energy and sustainable cooking techniques is pretty questionable as it is. Someone recently claimed in an email to me that people in the US have shown great interest in his solar cooker. It's a pity they couldn't show a bit more interest in reducing energy and resource consumption on a national level. And if every American family purchases one of those particular solar cookers, the amount of plastic needed to manufacture them will be phenomenal.

When people ask me if we all use solar cookers in Ireland, I tell them there is not enough sun. This is true, but does everyone there use wind, wave or tidal power? I don't think so. Come to think of it, one of the more dubious gems of wisdom sent from rich countries to poor countries recently is biofuels. In addition to using up scarce land, water and other resources, people here are very unlikely to make much money from such activities. They need food, not biofuels and they need to grow food for themselves, not accept handouts in return for biofuels. Enough land in developing countries has already been destroyed in order to produce cheap raw materials for rich countries.

Questions are now being raised about jatropha production, a biofuel crop that is said to grow in marginal land. Well, they say that about all biofuel crop production. Unsurprisingly, people at the Nairobi Trade Fair last week were promoting jatropha even for farmers with as little as one acre to spare for cash crops. Perhaps just about anything being hawked as good for small farmers by rich countries should be viewed with great suspicion. We in developed countries don't have a great reputation for telling the truth.

Questions are also constantly being raised about the effectiveness of aid, especially now that so many wealthy countries are feeling the pinch from the current financial crisis. Personally, I'm not against all aid or all aid agencies. However, much of the money that is called foreign aid is spent on furthering the economic, strategic and political interests of wealthy countries and corporations. The most important questions should be about how much 'aid' money even leaves the donor country and what (and whom) the money that does leave is being spent on. The idea that developed countries bestow lots of goodies on developing countries and get nothing in return is pure bullshit, but sadly not the biodigestible kind.


Friday, October 2, 2009

Nairobi Trade Fair and Solar Gadgets

A colleague and I went to the Nairobi Trade Fair yesterday. Many of the exhibits were the standard agricultural and small industrial production, crops, animals, goods such as rope and honey and the like. There were impressive fields of sunflowers, bananas and cabbage and well fattened cows, ostriches and sheep. And there was agricultural machinery aplenty for ploughing, preparing, irrigating, reaping and threshing.

But much of what I saw looked like it was aimed at rich or relatively rich farmers. The majority of farmers in Kenya are subsistence farmers with small amounts of land. They often aim to provide their household with some food and perhaps some surplus to sell. But they would not be able to afford the high grade machinery that was on offer. Even the machinery that was specifically aimed at 'small' farmers was very expensive. We were told that it was cost effective to grow an acre of jatropha for its oil seed crop, used for biofuels. But the machinery to press the oil would put most farmers off. And no farmer with only one acre would give it over to a cash crop.

Of course, farmers would be well advised to steer clear of biofuels anyhow. Their price are predicated on large scale production, which is, by definition, beyond the reach of small farmers. And producing energy products for Western countries is unlikely to make anyone in Kenya very rich, unless they are very rich already.

But farmers have been hoodwinked many times in the past to produce cash crops, such as sugar, tea, sisal and coffee. Small farmers have the most to lose when they find that it is not as productive as they were told. Some are giving up on these cash crops to find an alternative or even to grow food crops that they can use and sell the surplus of. But sadly, much of the best land in Kenya is already given over to inedible cash crops which only the wealthiest of farmers and dealers make money out of.

Millions face starvation because of lack of food, millions are malnourished because of the lack of variety in their diet. The current drought doesn't help but the gradual loss of land to inedible cash crops or large scale factory farming that is of little benefit and much detriment to the majority continues to push even more to the brink of starvation.

There seemed to be little evidence at the Nairobi Trade Fair that the Ministry of Agriculture and other large and official bodies there were reaching out to small farmers, producers and artisans. In fact, the 250 shilling entry fee and nearly 500 shilling travel costs just from Nakuru would keep most small farmers away, when many of them are lucky to get 150 shillings a day for their work.

There were exceptions. There were solar driers that allow people to save wasting much of their produce that they are unable to sell. There were solar cookers, something very close to my heart. The cookers are very affordable and can even be home made. Anyhow can make them. The driers are not so affordable but again, people can work out how to make them for themselves. There were cooking baskets which can be used to reduce use of solid fuels (and also made at home). And there were even improved cookers that claim to use less fuel or use various kinds of fuel.

But even some of the low cost exhibits forget just how little money people have. One of the improved cookers was ten times the cost of an ordinary 'jiko' or charcoal burning cooker. It's great to see innovative designs but until the inventors and developers of these products find out how to really reduce the cost to one that people just can't refuse, their work will lie on shelves.

Going back to solar cookers, I have tried to use a parabolic cooker, made by lining an umbrella with tinfoil. The focal point gets very hot and it should be possible to cook with it. But, alas, there has only been intermittent sun today so I just have to wait. But this design is only a prototype. Umbrellas and tinfoil are not very durable and they are not produced locally. In the long run, I'd like to be able to construct such a design using local materials, especially recycled materials.

Well, as always, I'll post my progress here as soon as I make further progress.