I have read various articles about the proposal to carry out a 'gay census' in Kenya. But none of them shed any light on why the Kenyan government should suddenly be interested in identifying some of those most at risk of being infected with and of transmitting HIV. The best way to make gay people feel they are not being singled out is to make HIV and sexual health services available to all, without prejudice.
In fact, the proposal is not just to single out men who have sex with men (MSM). The proposal also aims to identify commercial sex workers (CSW) and intravenous drug users (IDU). That's hardly going to make members of these groups feel any better. They all have several things in common: they are all doing something considered to be illegal. They are also the subject of prejudice, discrimination and condemnation by political and religious leaders.
Men who have sex with men, commercial sex workers and intravenous drug users need access to sexual health services. They also need access to more general health services, the protection of the law from persecution by members of the public and by the police. But programmes involving what is often referred to as 'harm reduction' are not popular in Kenya. The possibility of decriminalising sex between people of the same gender, commercial sex work or even intravenous drug use is not even being discussed right now.
So what strikes me as most suspicious about the call to carry out this gay census, or census of people who are most at risk from HIV, is that it is being funded by the President's Emergency Plan for Aids Relief (PEPFAR). PEPFAR has always been vehemently opposed to harm reduction measures, such as the use of condoms, needle exchange programmes and other activities that are known to help reduce the spread of HIV and other diseases.
Why would PEPFAR now be interested in funding this particular approach? Are we supposed to believe that the initiative has changed to such an extent that harm reduction is no longer refused funding? And are we also supposed to believe that the Kenyan government has completely reconsidered its earlier views on gay sex, commercial sex work and intravenous drug use?
I suspect the motives behind PEPFAR's decision to fund any kind of 'survey' of some of the most vulnerable people in the country. I suspect the Kenyan government's motives, too. I have heard rumours that a number of powerful people in the US are not completely unrelated to Uganda's current discussions of an effective pogrom against gay people. This is not the way to reduce HIV transmission and it will have numerous other human rights consequences.
Unless many other things are in place that guarantee the safety of people affected by this proposed 'survey', and that will include people who don't actually fall into any of the targeted groups, the whole thing should be abandoned immediately.
Friday, November 13, 2009
Thursday, November 12, 2009
Tomorrow's Disasters Are Preventable Today
I think most people, if they saw their child playing near a fire or in some other dangerous situation, would do something about it before an accident occurred. They wouldn't just watch and then shell out the money for hospital fees once an accident had occurred. But donor money is usually spent on clearing up after a disaster has hit.
Many children (and quite a number of adults) in developing countries are severely burned because most cooking is done on open fires, close to the ground. Donor money is sometimes forthcoming for the expensive surgery and skin grafts required by people who have suffered burns. But it's not often you come across substantial projects to provide people with alternatives to cooking on open fires, using mainly wood or charcoal.
Burning wood and charcoal accounts for a very large proportion of the carbon emissions from developing countries. Forests are fast disappearing and wood is getting more expensive and less viable as a fuel source. The use of wood and charcoal is part of a massive environemntal disaster. There are cheaper alternatives, such as solar cooking, biogas and the use of fuel briquettes made from combustible materials.
There is a lot to be gained from not burning wood and charcoal. There are the environmental benefits and safety benefits to consider. Also, people in close proximity to wood and charcoal cookers suffer from respiratory problems, one of the top killers in developing countries. Alternative fuels are cheaper, even free. And their use can reduce the time and effort taken to collect wood and produce charcoal.
But rather than see aid money go into proejcts that have these multiple advantages, we continue to direct it to big disasters. The children that suffer terrible burns, that we wish to see treated, shouldn't have to suffer these burns in the first place. The plastic and reconstructive surgeons should be concentrating on people who are not suffering from preventable injuries.
Similarly, money for surgeons and health resources is spent on reconstructing the faces of children affected by noma, which affects children suffering from malnutrition. Food security and proper nutrition would prevent many other illnesses and health conditions, in addition to noma, and would also reduce deaths, especially among infants and young people. Those who don't die from illnesses arising from insufficient food and nutrition still suffer stunted growth and retarded mental development. These are all avoidable.
The current debate about land grabbing in developing countries, where greedy multinationals are buying up huge tracts of land to grow food for rich countries, is an idle exercise if it does not go any way towards reducing this phenomenon substantially. By the time this land has been ravaged by industrial scale farming and contaminated by genetically modified organisms, it will be too late. What is the point knowing now what the consequences will be if we are not going to do anything about it?
Much of the land being grabbed is destined for biofuel production. The ridiculousness of starving people producing crops to fuel the cars of well fed people, far away, seems to be lost on us. We, the people benefitting from the increasing impoverishment of the poor, may be willing to see our governments giving large sums of aid money to starving people in the future, but we don't seem to want to do anything to prevent the circumstances that will eventually leave people starving.
Land grabbing, especially for biofuel production, results in food, water and other vital resources being exported from poor countries to rich countries. If we prevent the land grabbing now, we won't have to send aid money later to the disaster we are so busy creating.
Many children (and quite a number of adults) in developing countries are severely burned because most cooking is done on open fires, close to the ground. Donor money is sometimes forthcoming for the expensive surgery and skin grafts required by people who have suffered burns. But it's not often you come across substantial projects to provide people with alternatives to cooking on open fires, using mainly wood or charcoal.
Burning wood and charcoal accounts for a very large proportion of the carbon emissions from developing countries. Forests are fast disappearing and wood is getting more expensive and less viable as a fuel source. The use of wood and charcoal is part of a massive environemntal disaster. There are cheaper alternatives, such as solar cooking, biogas and the use of fuel briquettes made from combustible materials.
There is a lot to be gained from not burning wood and charcoal. There are the environmental benefits and safety benefits to consider. Also, people in close proximity to wood and charcoal cookers suffer from respiratory problems, one of the top killers in developing countries. Alternative fuels are cheaper, even free. And their use can reduce the time and effort taken to collect wood and produce charcoal.
But rather than see aid money go into proejcts that have these multiple advantages, we continue to direct it to big disasters. The children that suffer terrible burns, that we wish to see treated, shouldn't have to suffer these burns in the first place. The plastic and reconstructive surgeons should be concentrating on people who are not suffering from preventable injuries.
Similarly, money for surgeons and health resources is spent on reconstructing the faces of children affected by noma, which affects children suffering from malnutrition. Food security and proper nutrition would prevent many other illnesses and health conditions, in addition to noma, and would also reduce deaths, especially among infants and young people. Those who don't die from illnesses arising from insufficient food and nutrition still suffer stunted growth and retarded mental development. These are all avoidable.
The current debate about land grabbing in developing countries, where greedy multinationals are buying up huge tracts of land to grow food for rich countries, is an idle exercise if it does not go any way towards reducing this phenomenon substantially. By the time this land has been ravaged by industrial scale farming and contaminated by genetically modified organisms, it will be too late. What is the point knowing now what the consequences will be if we are not going to do anything about it?
Much of the land being grabbed is destined for biofuel production. The ridiculousness of starving people producing crops to fuel the cars of well fed people, far away, seems to be lost on us. We, the people benefitting from the increasing impoverishment of the poor, may be willing to see our governments giving large sums of aid money to starving people in the future, but we don't seem to want to do anything to prevent the circumstances that will eventually leave people starving.
Land grabbing, especially for biofuel production, results in food, water and other vital resources being exported from poor countries to rich countries. If we prevent the land grabbing now, we won't have to send aid money later to the disaster we are so busy creating.
Monday, November 9, 2009
Widespread Environmental Contamination and Loss of Biodiversity Are 'Externalities' to the GM Industry
The Kenyan government has been persuaded that it can 'revive' the country's cotton industry by introducing genetically modified GM cotton varieties. The first thing that springs to mind is the principle reason for the death of cotton industries in Kenya and every other developing country in the world: subsidies for American cotton farmers. It is not possible for poor countries to produce cotton at a price that can compete with the heavily subsidized American cotton, which is why most country's cotton industries failed many years ago.
Of course, these American subsidies are illegal and they are completely antithetical to the country's constant bleating about the importance of free trade. But double standards have never mattered to rich countries and they never will.
There may well be theoretical benefits to GM organisms, such as cotton, it's hard to know. The GM industry has been pumping out inaccurate and misleading data on trials for so long that they probably don't even know what is true and what isn't by now, and probably don't care much, either.
But the problems that will arise if farmers buy into the thirty pieces of GM silver are more obvious, for those who can be bothered about them. The GM producer in question, Monsanto, which has an unrivalled corporate social responsibility record, claims that farmers will save on pesticide costs because they have to spray less frequently. Unfortunately, they will be obliged to pay more for seeds, spray using expensive pesticides produced by Monsanto and the land they spray will be denuded of all species, from the microscopic up. Expensive Monsanto herbicides will do the same for any plant species.
This is a mere externality to Monsanto and probably to the Kenyan government. The fact that the land and water surrounding land planted with this cotton will be contaminated, probably irreversibly, is also an externality and those promoting the introduction of GM cotton even have the cheek (or ignorance) to claim that it will have a positive impact on the environment and the health of those working on cotton plantations.
In addition to the problem of having to buy seed every year from Monsanto, because it's not possible or even permissible to collect seed at the end of the season, it will be difficult for the farmers to get out of the grip of Monsanto, if and when they wish to. Their land and the land around will be contaminated with the GM cotton for generations and even these contaminated crops could be deemed to the be intellectual property of those generous people at Monsanto.
Many of the claims put about by GM hawkers are yet to be backed up by evidence but even they make little effort now to deny that GM crops are unlikely to be of any benefit to small farmers. The vast majority of farmers in Kenya and other developing countries are subsistence farmers who aim to grow enough food to live on and sometimes grow some cash crops to supplement their income. Although various cash crops have long been foisted on small farmers, many have felt the sting of becoming locked into producing things like tea, sisal, coffee, sugar and biofuels, for example, only to find that yields and prices never match up to what they were promised.
Small farmers who buy into GM crops need to ask themselves if they can afford to become locked into yet another non-food crop that will never be truly economical and may leave them worse off than before. Large scale farmers may not experience the same worries, but whole communities in Kenya and other countries need to consider what the potential effects of widespread contaminated land and water may be. They also need to consider the consequences of most of their food production being owned by a multinational that is not even bound by the country's laws.
It's worthwhile for Kenyans to bear in mind that cotton industries in developing countries did not decline because of pests and other problems but because a more powerful country controls the market. This is not likely to change quickly and the Americans are not going to give up the level of control that they have cheated so hard to obtain. Similar remarks apply to other GM crops. GM is not a technology for the poor, it is a technology for the powerful, like many technologies. But of course, it's of less use to the powerful unless the poor believe that they too need GM technology.
Of course, these American subsidies are illegal and they are completely antithetical to the country's constant bleating about the importance of free trade. But double standards have never mattered to rich countries and they never will.
There may well be theoretical benefits to GM organisms, such as cotton, it's hard to know. The GM industry has been pumping out inaccurate and misleading data on trials for so long that they probably don't even know what is true and what isn't by now, and probably don't care much, either.
But the problems that will arise if farmers buy into the thirty pieces of GM silver are more obvious, for those who can be bothered about them. The GM producer in question, Monsanto, which has an unrivalled corporate social responsibility record, claims that farmers will save on pesticide costs because they have to spray less frequently. Unfortunately, they will be obliged to pay more for seeds, spray using expensive pesticides produced by Monsanto and the land they spray will be denuded of all species, from the microscopic up. Expensive Monsanto herbicides will do the same for any plant species.
This is a mere externality to Monsanto and probably to the Kenyan government. The fact that the land and water surrounding land planted with this cotton will be contaminated, probably irreversibly, is also an externality and those promoting the introduction of GM cotton even have the cheek (or ignorance) to claim that it will have a positive impact on the environment and the health of those working on cotton plantations.
In addition to the problem of having to buy seed every year from Monsanto, because it's not possible or even permissible to collect seed at the end of the season, it will be difficult for the farmers to get out of the grip of Monsanto, if and when they wish to. Their land and the land around will be contaminated with the GM cotton for generations and even these contaminated crops could be deemed to the be intellectual property of those generous people at Monsanto.
Many of the claims put about by GM hawkers are yet to be backed up by evidence but even they make little effort now to deny that GM crops are unlikely to be of any benefit to small farmers. The vast majority of farmers in Kenya and other developing countries are subsistence farmers who aim to grow enough food to live on and sometimes grow some cash crops to supplement their income. Although various cash crops have long been foisted on small farmers, many have felt the sting of becoming locked into producing things like tea, sisal, coffee, sugar and biofuels, for example, only to find that yields and prices never match up to what they were promised.
Small farmers who buy into GM crops need to ask themselves if they can afford to become locked into yet another non-food crop that will never be truly economical and may leave them worse off than before. Large scale farmers may not experience the same worries, but whole communities in Kenya and other countries need to consider what the potential effects of widespread contaminated land and water may be. They also need to consider the consequences of most of their food production being owned by a multinational that is not even bound by the country's laws.
It's worthwhile for Kenyans to bear in mind that cotton industries in developing countries did not decline because of pests and other problems but because a more powerful country controls the market. This is not likely to change quickly and the Americans are not going to give up the level of control that they have cheated so hard to obtain. Similar remarks apply to other GM crops. GM is not a technology for the poor, it is a technology for the powerful, like many technologies. But of course, it's of less use to the powerful unless the poor believe that they too need GM technology.
Sunday, November 8, 2009
Lack of Sanitary Pads is a Threat to the Health of Kenya as a Whole
The hype about how brilliant the introduction of 'free' primary education has been in Kenya continues six years on but the reality is that most parents who couldn't afford primary education before 2003 still can't afford it. The hidden costs are endless and include levies for parent teacher associations, uniforms and overpriced books, equipment, 'extra' tuition, etc. A colleague recently pointed out to me that parents need to pay for their child's desk every year. There must be quite a surplus of desks in schools by now.
While enrollment figures are high for state schools, they have dropped in many private schools and the figures for attendance and completion, even of primary school, are not so brilliant. Numbers of girls completing primary school and going on to secondary school are particularly poor. There are many reasons for girls not completing their education, including the belief that as girls will marry into another family, it is not economical to 'water ones neighbour's fields'.
But a study in Uganda suggests that many girls are dropping out of school as soon as they start menstruating. Schools are not equipped to deal with girls once they start menstruating, apparently. Lack of separate sanitary facilities for girls, and even lack of water, mean that they will often stay at home, either for the duration of their period or even for good.
The extremely high cost of sanitary pads mean that they are inaccessible to many girls. They have to use substitutes or stay at home. To put it in perspective, ten of the cheapest sanitary pads cost more than several days worth of the staple ground maize for a large family. The commonly advertised branded versions cost twice or three times as much and, because one or two of them are sometimes given out as promotional 'gifts', some people think they must always use this version to be really safe.
As well as having to teach sex education without talking about sex, teachers are also in the position where they are usually not trained to include classes about menstruation, either. Teaching about the whole field of sex, sexuality, reproduction, sexual health and sanitation is often considered to lead to immoral behaviour in young people. This can be blamed on taboo or cultural considerations but in fact, it often has more to do with political and religious leadership and funding sources for sex education and education as a whole.
In the end, large numbers of girls with little or no education means that large numbers of children will, in the future, also be brought up with little or no education, knowledge of sex or reproduction or even with the level of empowerment needed to change anything for the better. Continuing gender imbalances mean continuation of the status quo. That's a status quo where much of the population will never be able to attain a decent standard of living, while the more privileged continue to enjoy the great wealth that exists in Kenya (despite the best attempts of colonials, neo-colonials, multinationals and other assorted leeches).
The introduction of 'free' primary education was a little like some of the other initiatives that only aim to tackle one or two headline indicators. (In fact, any of the millennium development goals (MDG) would be additional examples.) School fees were abolished but immediately replaced with costs that mean parents still have to pay de facto fees. There are still far too few teachers and classrooms in many areas to provide decent levels of education.
When it comes to education relating to sex, reproduction, health, sanitation or anything like that, few teachers have been trained to provide these. And there is little to be gained from health and sanitation education when the health and sanitation facilities, even reliable supplies of clean water, are not available to the majority.
Successive governments, along with those who dream up international 'initiatives' don't seem to have noticed that basic needs are basic for the very reason that, without any one of them, people's standard of living is compromised. Children who have little or no food for much of the time will have retarded growth and mental development, poor health and a short life. Lack of sanitary facilities reduce health but this also reduces access to education and the efficacy of education. Basic needs are connected to each other, so you can't just make a list and tick them off as you create an 'initiative' that relates to each one.
While enrollment figures are high for state schools, they have dropped in many private schools and the figures for attendance and completion, even of primary school, are not so brilliant. Numbers of girls completing primary school and going on to secondary school are particularly poor. There are many reasons for girls not completing their education, including the belief that as girls will marry into another family, it is not economical to 'water ones neighbour's fields'.
But a study in Uganda suggests that many girls are dropping out of school as soon as they start menstruating. Schools are not equipped to deal with girls once they start menstruating, apparently. Lack of separate sanitary facilities for girls, and even lack of water, mean that they will often stay at home, either for the duration of their period or even for good.
The extremely high cost of sanitary pads mean that they are inaccessible to many girls. They have to use substitutes or stay at home. To put it in perspective, ten of the cheapest sanitary pads cost more than several days worth of the staple ground maize for a large family. The commonly advertised branded versions cost twice or three times as much and, because one or two of them are sometimes given out as promotional 'gifts', some people think they must always use this version to be really safe.
As well as having to teach sex education without talking about sex, teachers are also in the position where they are usually not trained to include classes about menstruation, either. Teaching about the whole field of sex, sexuality, reproduction, sexual health and sanitation is often considered to lead to immoral behaviour in young people. This can be blamed on taboo or cultural considerations but in fact, it often has more to do with political and religious leadership and funding sources for sex education and education as a whole.
In the end, large numbers of girls with little or no education means that large numbers of children will, in the future, also be brought up with little or no education, knowledge of sex or reproduction or even with the level of empowerment needed to change anything for the better. Continuing gender imbalances mean continuation of the status quo. That's a status quo where much of the population will never be able to attain a decent standard of living, while the more privileged continue to enjoy the great wealth that exists in Kenya (despite the best attempts of colonials, neo-colonials, multinationals and other assorted leeches).
The introduction of 'free' primary education was a little like some of the other initiatives that only aim to tackle one or two headline indicators. (In fact, any of the millennium development goals (MDG) would be additional examples.) School fees were abolished but immediately replaced with costs that mean parents still have to pay de facto fees. There are still far too few teachers and classrooms in many areas to provide decent levels of education.
When it comes to education relating to sex, reproduction, health, sanitation or anything like that, few teachers have been trained to provide these. And there is little to be gained from health and sanitation education when the health and sanitation facilities, even reliable supplies of clean water, are not available to the majority.
Successive governments, along with those who dream up international 'initiatives' don't seem to have noticed that basic needs are basic for the very reason that, without any one of them, people's standard of living is compromised. Children who have little or no food for much of the time will have retarded growth and mental development, poor health and a short life. Lack of sanitary facilities reduce health but this also reduces access to education and the efficacy of education. Basic needs are connected to each other, so you can't just make a list and tick them off as you create an 'initiative' that relates to each one.
Friday, November 6, 2009
HIV Treatment is Necessary, But Not Sufficient, For Prevention
Medicins Sans Frontieres (MSF) has published a report on reduced funding for HIV treatment, from the World Bank's Global Fund and the US Government's President's Emergency Fund for Aids Relief (PEPFAR) in particular. MSF have good reason to be worried.
The pharmaceutical industry successfully lobbied governments and international institutions to pay huge amounts of money for antiretroviral (ARV) drugs that most of the people suffering from HIV/Aids would never be able to afford. In fact, the governments of countries with high rates of HIV/Aids would never be able to afford these drugs, either.
Countries like Kenya have the option to produce generic versions of ARV drugs at a fraction of the price that is currently being paid. But most countries, including Kenya, have chosen not to exercise this right, preferring to enact laws that make it unlikely that the country can produce or even purchase such cheap generic versions. Good relations with the pharmaceutical industry seems to be more important to them than saving the lives of their citizens.
MSF are right, huge ARV rollouts cannot now be stopped without endangering the lives of millions of people who are HIV positive and even people who are, as yet, HIV negative. But rather than arguing for the money to keep coming, in fast increasing amounts, they could concentrate on finding ways of reducing the cost of treatment so that it can continue and even expand.
How much of the billions of dollars of aid money have been spent on building factories to produce drugs that people need in Kenya? I haven't heard of any. Most of the money has been spent in ways that don't go on to produce anything or increase the country's sustainability or self reliance. The funds have mostly been spent as if HIV is just an emergency.
Well, it is something of an emergency, but there are underlying factors that are not part of an emergency. The country has a decaying health service, decaying education sector and a small and decaying infrastructure. People are poor, unhealthy, badly educated and unable to access vital services, such as clean water and proper sanitation. These are the things that face the majority of Kenyans every day, whether they are HIV positive or not.
Money spent on drugs, regardless of the overall condition of health systems is, to a large extent, wasted. Many drugs go out of date before being distributed, they get to people unprepared to take them properly, they are taken by people who are dying of other, easily prevented and treated illnesses, etc. My argument is not that ARVs should not be purchased and distributed and prescribed; it is that there needs to be a proper, accessible health service for all this to happen.
There is not a proper health infrastructure in Kenya, there hasn't been for a long time and increased HIV/Aids funding has not brought about a health infrastructure that serves people's needs. True, there are many clinics and institutions that were not here before HIV/Aids and wouldn't have even appeared. But these mostly deal with HIV/Aids, not other, basic health problems that people face.
My argument is also directed at the emphasis on HIV/Aids treatment over prevention. MSF's Goemaere is right to object to the prevention/treatment 'dichotomy'. Of course treatment has a positive effect on prevention efforts. But it is not enough to try to treat our way out of the epidemic. This is clearly not working and much more needs to be done to prevent new infections. Otherwise, the aim to treat everyone who requires treatment becomes even less attainable and less sustainable that it is right now.
People who are HIV positive need more than just drugs, or even treatment. There are a lot of threats to their health and welfare than HIV. They are dying because they are too far from the hospital, because the hospital is not up to the job of caring for them, because they are entitled to benefits they don't know about or that have been stolen by someone else, because they are poor and isolated and not considered important enough. But there just aren't the services needed to support chronically sick people and these will not just appear because the country is swamped by HIV/Aids (treatment) related institutions and programmes.
Those who are HIV negative need to stay that way and this won't happen by rolling out ARVs, alone. They have needs that are far more important and urgent that the possibility that they may become infected by something that won't kill them for many years. Most won't live for very long anyway, for a huge variety of reasons that are not being addressed right now.
Goemaere recognises the false dichotomy of treatment/prevention, but fails to see that increasing treatment while effectively ignoring prevention will not combat HIV/Aids in the long run. Assuming that HIV treatment will also prevent infections is not enough because it doesn't prevent enough infections and it never will. And treatment will never be as efficient as it should be if health, education, infrastructure and other social services continue to be ignored.
The pharmaceutical industry successfully lobbied governments and international institutions to pay huge amounts of money for antiretroviral (ARV) drugs that most of the people suffering from HIV/Aids would never be able to afford. In fact, the governments of countries with high rates of HIV/Aids would never be able to afford these drugs, either.
Countries like Kenya have the option to produce generic versions of ARV drugs at a fraction of the price that is currently being paid. But most countries, including Kenya, have chosen not to exercise this right, preferring to enact laws that make it unlikely that the country can produce or even purchase such cheap generic versions. Good relations with the pharmaceutical industry seems to be more important to them than saving the lives of their citizens.
MSF are right, huge ARV rollouts cannot now be stopped without endangering the lives of millions of people who are HIV positive and even people who are, as yet, HIV negative. But rather than arguing for the money to keep coming, in fast increasing amounts, they could concentrate on finding ways of reducing the cost of treatment so that it can continue and even expand.
How much of the billions of dollars of aid money have been spent on building factories to produce drugs that people need in Kenya? I haven't heard of any. Most of the money has been spent in ways that don't go on to produce anything or increase the country's sustainability or self reliance. The funds have mostly been spent as if HIV is just an emergency.
Well, it is something of an emergency, but there are underlying factors that are not part of an emergency. The country has a decaying health service, decaying education sector and a small and decaying infrastructure. People are poor, unhealthy, badly educated and unable to access vital services, such as clean water and proper sanitation. These are the things that face the majority of Kenyans every day, whether they are HIV positive or not.
Money spent on drugs, regardless of the overall condition of health systems is, to a large extent, wasted. Many drugs go out of date before being distributed, they get to people unprepared to take them properly, they are taken by people who are dying of other, easily prevented and treated illnesses, etc. My argument is not that ARVs should not be purchased and distributed and prescribed; it is that there needs to be a proper, accessible health service for all this to happen.
There is not a proper health infrastructure in Kenya, there hasn't been for a long time and increased HIV/Aids funding has not brought about a health infrastructure that serves people's needs. True, there are many clinics and institutions that were not here before HIV/Aids and wouldn't have even appeared. But these mostly deal with HIV/Aids, not other, basic health problems that people face.
My argument is also directed at the emphasis on HIV/Aids treatment over prevention. MSF's Goemaere is right to object to the prevention/treatment 'dichotomy'. Of course treatment has a positive effect on prevention efforts. But it is not enough to try to treat our way out of the epidemic. This is clearly not working and much more needs to be done to prevent new infections. Otherwise, the aim to treat everyone who requires treatment becomes even less attainable and less sustainable that it is right now.
People who are HIV positive need more than just drugs, or even treatment. There are a lot of threats to their health and welfare than HIV. They are dying because they are too far from the hospital, because the hospital is not up to the job of caring for them, because they are entitled to benefits they don't know about or that have been stolen by someone else, because they are poor and isolated and not considered important enough. But there just aren't the services needed to support chronically sick people and these will not just appear because the country is swamped by HIV/Aids (treatment) related institutions and programmes.
Those who are HIV negative need to stay that way and this won't happen by rolling out ARVs, alone. They have needs that are far more important and urgent that the possibility that they may become infected by something that won't kill them for many years. Most won't live for very long anyway, for a huge variety of reasons that are not being addressed right now.
Goemaere recognises the false dichotomy of treatment/prevention, but fails to see that increasing treatment while effectively ignoring prevention will not combat HIV/Aids in the long run. Assuming that HIV treatment will also prevent infections is not enough because it doesn't prevent enough infections and it never will. And treatment will never be as efficient as it should be if health, education, infrastructure and other social services continue to be ignored.
Wednesday, November 4, 2009
Lomborg Preaching to the Converted, Again
As we (Ribbon of Hope) go about, visiting our various clients in and around Nakuru, we see the many and fast changing problems that people here face. Some people get through these problems well enough, others don't. It's always hard to figure out if some make it through because they are better off than others or if they are better off because they are good at getting through problems or if there is a mixture of factors.
The rains have come in some areas. This means that it is time to plant crops. If the right preparations have been made, the crops should grow and if the rains continue, there will be a good harvest. But now the rains are here, are people preparing to harvest rainwater in order to ensure they get through the next drought? Sadly, not many people harvest rainwater. This doesn't appear to be a government priority either. The government even talked about distributing cheap or free seeds and fertilizer but now, there appears to be a shortage of both seeds and fertilizer because, well, er, the government has bought up so much of them. They must have just forgotten to distribute them.
In other areas, the rains have brought too much, too quickly, and have washed away fields, crops, roads, bridges, houses and anything else in their path. Were provisions made for flooding? It appears not. Roads that have been swept away in Coast Province were not flood proof. Floods occur with amazing regularity but flood proofing is an optional extra.
There have been power cuts again recently, despite promises that these would become a thing of the past. The government, it has been claimed, have now got the extra oil they need to make up for the shortfalls in power. Perhaps they will sort it out before the next fuel shortage. But fuel shortages, like floods, droughts, famines and other disasters keep occurring and will continue to occur. They need to be planned for. Last year, politicians were talking knowingly about planning for such disasters but there is little evidence that they have achieved anything yet.
The antics of the 'environmentalist' Bjorn Lomborg are well known to those who are interested in environmental issues but Nairobi appears to have the dubious pleasure of hosting a conference organised by Lomborg's 'think tank', the Copenhagen Consensus Centre.
Strangely enough, Lomborg appears to make a valid point about the need to concentrate on some very cheap, efficient and vital development programmes, such as micro-nutrient deficiencies and intestinal parasite infestations, which affect billions of people. However, there is a need to ensure that these billions of people have access to a balanced diet. The cheapest and most sustainable solution to these problems is not to enhance foods with various supplements and to produce things like vitamin A enriched chewing gum and other headline grabbing stories. There are already plenty of foods rich in vitamin A and other micro-nutrients. It's just that many people are too poor to afford them.
Lomborg also uses the opportunity given by this smokescreen to plug his tired old argument that climate change is not caused by human activities and that we need to adapt to it rather than trying to fight it. If the money and effort spent on denying that climate change is caused by human activities were to be spent on worthwhile causes, such as the ones Lomborg mentions, a lot of good work could have been achieved by now.
Kenya can't afford to risk accepting Lomborg's puny argument. Whether climate change is caused by human activities or not, the government has to put money into sustainable sources of energy for two reasons: first, these sources of energy will still be available for the foreseeable future, unlike fossil fuels; second, the country is not able to afford these expensive and unsustainable sources of energy and they are not able to afford the costs that go with high usage of unsustainable energy sources.
On the other hand, Kenya can afford to invest in wind power (as long as they produce their own generators, rather than buying the ridiculously expensive British ones that the UK government seems hell bent on selling them); they can afford hydrothermal power, solar power, biogas and probably all sorts of other ways of reducing the country's energy bill and the bill for the pollution and environmental damage that has taken place and that continues to take place.
But what is the government doing? Boasting about the possibility of finding oil in the Eastern Province. Billions have been sunk in drilling for oil in Kenya but the point is not that they have diddly squat to show for it. The point is that they don't need to spend all this money on fossil fuels when there are so many alternatives available here.
And the politicians will continue talking about flood proofing now the rains have come and they will surely talk about rainwater harvesting when the rains have gone away. If oil is discovered, they will rake in the money and when the oil has gone they will talk about how long term thinking is required. But I guess you can't blame Lomborg for talking the Kenyan government into stupid energy policies and development agenda. Because people who listen to such arguments seem to want to believe them.
And the bit that Lomborg gets right, that we could achieve a lot by working on micro-nutrient deficiencies and intestinal parasites, has long been recognised. But these are issues that the Kenyan government has little to say about.
The rains have come in some areas. This means that it is time to plant crops. If the right preparations have been made, the crops should grow and if the rains continue, there will be a good harvest. But now the rains are here, are people preparing to harvest rainwater in order to ensure they get through the next drought? Sadly, not many people harvest rainwater. This doesn't appear to be a government priority either. The government even talked about distributing cheap or free seeds and fertilizer but now, there appears to be a shortage of both seeds and fertilizer because, well, er, the government has bought up so much of them. They must have just forgotten to distribute them.
In other areas, the rains have brought too much, too quickly, and have washed away fields, crops, roads, bridges, houses and anything else in their path. Were provisions made for flooding? It appears not. Roads that have been swept away in Coast Province were not flood proof. Floods occur with amazing regularity but flood proofing is an optional extra.
There have been power cuts again recently, despite promises that these would become a thing of the past. The government, it has been claimed, have now got the extra oil they need to make up for the shortfalls in power. Perhaps they will sort it out before the next fuel shortage. But fuel shortages, like floods, droughts, famines and other disasters keep occurring and will continue to occur. They need to be planned for. Last year, politicians were talking knowingly about planning for such disasters but there is little evidence that they have achieved anything yet.
The antics of the 'environmentalist' Bjorn Lomborg are well known to those who are interested in environmental issues but Nairobi appears to have the dubious pleasure of hosting a conference organised by Lomborg's 'think tank', the Copenhagen Consensus Centre.
Strangely enough, Lomborg appears to make a valid point about the need to concentrate on some very cheap, efficient and vital development programmes, such as micro-nutrient deficiencies and intestinal parasite infestations, which affect billions of people. However, there is a need to ensure that these billions of people have access to a balanced diet. The cheapest and most sustainable solution to these problems is not to enhance foods with various supplements and to produce things like vitamin A enriched chewing gum and other headline grabbing stories. There are already plenty of foods rich in vitamin A and other micro-nutrients. It's just that many people are too poor to afford them.
Lomborg also uses the opportunity given by this smokescreen to plug his tired old argument that climate change is not caused by human activities and that we need to adapt to it rather than trying to fight it. If the money and effort spent on denying that climate change is caused by human activities were to be spent on worthwhile causes, such as the ones Lomborg mentions, a lot of good work could have been achieved by now.
Kenya can't afford to risk accepting Lomborg's puny argument. Whether climate change is caused by human activities or not, the government has to put money into sustainable sources of energy for two reasons: first, these sources of energy will still be available for the foreseeable future, unlike fossil fuels; second, the country is not able to afford these expensive and unsustainable sources of energy and they are not able to afford the costs that go with high usage of unsustainable energy sources.
On the other hand, Kenya can afford to invest in wind power (as long as they produce their own generators, rather than buying the ridiculously expensive British ones that the UK government seems hell bent on selling them); they can afford hydrothermal power, solar power, biogas and probably all sorts of other ways of reducing the country's energy bill and the bill for the pollution and environmental damage that has taken place and that continues to take place.
But what is the government doing? Boasting about the possibility of finding oil in the Eastern Province. Billions have been sunk in drilling for oil in Kenya but the point is not that they have diddly squat to show for it. The point is that they don't need to spend all this money on fossil fuels when there are so many alternatives available here.
And the politicians will continue talking about flood proofing now the rains have come and they will surely talk about rainwater harvesting when the rains have gone away. If oil is discovered, they will rake in the money and when the oil has gone they will talk about how long term thinking is required. But I guess you can't blame Lomborg for talking the Kenyan government into stupid energy policies and development agenda. Because people who listen to such arguments seem to want to believe them.
And the bit that Lomborg gets right, that we could achieve a lot by working on micro-nutrient deficiencies and intestinal parasites, has long been recognised. But these are issues that the Kenyan government has little to say about.
Tuesday, November 3, 2009
Ribbon of Hope Self Help Group, Nakuru
Having come all the way to Nakuru to work for an NGO that turned out not to have any projects at present, I was lucky enough to end up working with some people who have a lot going on. Ribbon of Hope is a community based self help organisation. It was initially set up to work with HIV positive people but quickly evolved to support people who are in need of support for whatever reason.
Ribbon of Hope works with local self help groups, advising on and helping with relevant training, sources of finance, income generation schemes and ways of cutting household costs. Members of various local groups are engaged in producing food and other goods and services. Ribbon of Hope has raised the money to rent land and cover the costs of setting up a number of projects. They work closely with the local support groups, ensuring that everything is monitored and controlled adequately and they even go out into the fields to dig, plant and harvest crops.
At present, Ribbon of Hope is trying out new ways of making and saving money, such as solar cookers, fuel briquettes made from organic waste, homemade, reusable sanitary towels and various other techniques. The aim is to find things that are very cheap or completely free and that people with any level of education can avail of. Some people will only want to use the cookers, briquettes and sanitary towels. But others will want to learn how to make them and then sell them on to others.
In addition to these activities, people are involved in more traditional ways of making and saving money, such as growing maize and beans, rearing hens and cows and making jewellery and basketry products. In this way, people who work hard are more or less guaranteed some money, food or other goods. But the additional activities are intended to branch out from things that most self help groups are already doing, and to find some highly sustainable activities that have multiple benefits for those involved. Ribbon of Hope are researching and experimenting with anything that looks like it might help with their work.
It is important to find income generation and cost saving activities that are free or very low cost for two reasons: money is in short supply, pretty much everywhere; but, more importantly, many people in countries like Kenya realise that they need to become more self reliant. Many of the poorer people here have been depending on unsustainable sources of income and support for a long time. They are tired of having to go around to one NGO after another to take advantage of what usually turns out to be a short term hand out to tide them over from one crisis to the next. They don't see Ribbon of Hope as another source of handouts but as a way of getting away from handouts.
In the long term, the poorest people will need to find ways to raise their own living standards. They know that the huge amounts of aid money that come into the country usually end up in the pockets of those who are already well off, politicians, business people, churches and big NGOs. Kenyans have witnessed this over and over again and they don't expect it to change. All that the most active members of these local self help groups need is some initial assistance, in the form of small amounts of money and some good advice. They do the hard work themselves.
Sadly, there are people who are neither productive not supportive. Some are even outrightly destructive. So those who put a lot of work into improving their standard of living also need people to advocate for change, so that they can enjoy the fruits of their hard work. But as they become more self reliant and better able to avoid the effects of those who don't want them to succeed, they should also become better able to advocate for themselves. This function of advocating for and supporting self help groups is one of the most vital roles that Ribbon of Hope plays.
We are interested in hearing from other groups, especially community based groups, who are involved in low cost, sustainable projects that can be implemented regardless of levels of education or skills. In turn, we are happy to tell anyone who is interested about our experiences as we go along. I'll be documenting much of our day to day work on this blog but please feel free to get in touch if you have any questions.
Ribbon of Hope works with local self help groups, advising on and helping with relevant training, sources of finance, income generation schemes and ways of cutting household costs. Members of various local groups are engaged in producing food and other goods and services. Ribbon of Hope has raised the money to rent land and cover the costs of setting up a number of projects. They work closely with the local support groups, ensuring that everything is monitored and controlled adequately and they even go out into the fields to dig, plant and harvest crops.
At present, Ribbon of Hope is trying out new ways of making and saving money, such as solar cookers, fuel briquettes made from organic waste, homemade, reusable sanitary towels and various other techniques. The aim is to find things that are very cheap or completely free and that people with any level of education can avail of. Some people will only want to use the cookers, briquettes and sanitary towels. But others will want to learn how to make them and then sell them on to others.
In addition to these activities, people are involved in more traditional ways of making and saving money, such as growing maize and beans, rearing hens and cows and making jewellery and basketry products. In this way, people who work hard are more or less guaranteed some money, food or other goods. But the additional activities are intended to branch out from things that most self help groups are already doing, and to find some highly sustainable activities that have multiple benefits for those involved. Ribbon of Hope are researching and experimenting with anything that looks like it might help with their work.
It is important to find income generation and cost saving activities that are free or very low cost for two reasons: money is in short supply, pretty much everywhere; but, more importantly, many people in countries like Kenya realise that they need to become more self reliant. Many of the poorer people here have been depending on unsustainable sources of income and support for a long time. They are tired of having to go around to one NGO after another to take advantage of what usually turns out to be a short term hand out to tide them over from one crisis to the next. They don't see Ribbon of Hope as another source of handouts but as a way of getting away from handouts.
In the long term, the poorest people will need to find ways to raise their own living standards. They know that the huge amounts of aid money that come into the country usually end up in the pockets of those who are already well off, politicians, business people, churches and big NGOs. Kenyans have witnessed this over and over again and they don't expect it to change. All that the most active members of these local self help groups need is some initial assistance, in the form of small amounts of money and some good advice. They do the hard work themselves.
Sadly, there are people who are neither productive not supportive. Some are even outrightly destructive. So those who put a lot of work into improving their standard of living also need people to advocate for change, so that they can enjoy the fruits of their hard work. But as they become more self reliant and better able to avoid the effects of those who don't want them to succeed, they should also become better able to advocate for themselves. This function of advocating for and supporting self help groups is one of the most vital roles that Ribbon of Hope plays.
We are interested in hearing from other groups, especially community based groups, who are involved in low cost, sustainable projects that can be implemented regardless of levels of education or skills. In turn, we are happy to tell anyone who is interested about our experiences as we go along. I'll be documenting much of our day to day work on this blog but please feel free to get in touch if you have any questions.
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