Author Archives: Katie

Mr. Thursday’s Book Shelf: PATHOLOGIES OF POWER

“First, to what level of quality can medical ethics aspire, if it ignores callous discrimination in medical practice against large populations of the innocent poor? Second, how effective can such theories be in addressing the critical issues of medical and clinical ethics if they are unable to contribute to the closing of the gap of socio-medical disparity?”
–Marcio Fabri dos Anjos “ Medical Ethics in the Developing World: A Liberation Theology Perspective”

I took a class in college on medical ethics. Professor Peluchon, a tiny blond professora from southern France, tried to explain to my class (mostly pre-med students and one philosophy major who was, uh, me) the intricacies of ethics concerning End-of-Life issues such as euthanasia or palliative care (treatment which alleviates symptoms without treating the underlying cause). She taught about the utilitarian approach of stem-cell researchers and abortion clinics. She focused on topics that will be important to medical practitioners who will work in the suburbs of America in the future.

Now, I don’t like to think of myself as small-minded, but I didn’t even begin to consider the questions of medical ethics that concern over one sixth of humanity. I thought of medical ethics as abortion, palliative care, drug abuse, and just nominally The Tuskegee Experiment. However, I never took my questions to the next step. I never considered the larger picture. I never looked outside of US healthcare needs, and even then, I barely considered America’s destitute. That’s where Paul Farmer comes in.

Paul Farmer is a Harvard and Duke educated doctor and medical anthropologist. He works in one of the best hospitals in the United States, Brigham and Women’s Hospital in Boston, MA. He co-founded an internationally recognized medical non-profit, Partners in Health. He has also dedicated his life to working with individuals in the Central Plateau of Haiti, and he has been doing it for over twenty-years. I first learned about Paul Farmer’s work in Kenya this summer. Another volunteer raved about him as being inspiring and tenacious. Reading his biography and some of his own books not only inspired her to work in a clinic in Western Kenya, but he also inspired her to return to school for a nursing degree.

Pathologies of Power is Paul Farmer’s unveiling of a new worldview. It is a worldview that has been violently apparent to the silent multitude for decades, but ignored by the minority who possess power. Those who die prematurely from disease, those who are sentenced to death by disease, and those who are used or ignored by Western medicine are the focus of this book. Farmer asserts, through individual stories and grandiose theory (liberation theology), that the international community has an inherently flawed view of aid especially concerning healthcare. Structural violence enacted against the world’s most desperate cannot be their fault. It is the fault of the Western market economy. And it is the duty of the West to correct this.

He decries the West for focusing on “the right to vote” as opposed to “the right to survival”. He exposes the hypocrisy of Western leaders who proclaim that sufficient care for those with Multi Drug Resistant Tuberculosis (MDRTB) is “not cost effective” although they would demand the best care for themselves. He challenges the reader to truly recognize that all human beings deserve to be treated with respect.

For example, recently there was a study conducted in Uganda that found that circumcision reduces risks for HIV transmission in heterosexual couples. That’s all good. What wasn’t widely reported was that participants (who participated under the promise that they would receive medical care) were not provided any antiretroviral drugs and their spouses or partners were not to be advised of the participants’ HIV status. These individuals were a control group. Those who ran the study believed that their actions were justified for the greater good.

Pathologies of Power forces one to consider the tragic irony of the international aid apparatus. The World Trade Organization is designed to provide guidance on improving healthcare for the world. However, it is restrained by donor states who don’t want to hear that a new TB program in Bolivia will save millions of lives except will be very costly. They’d rather have a program that will save thousands of lives and be “cost effective” or “sustainable”. Paul Farmer rejects this approach. To his (and the book’s) detriment, he is unable to provide an alternative approach to healthcare that improves state apparatus’ from the inside out. He only approves of programs that ensure large influxes of capital into failing health infrastructure. How can progress be maintained? If he has an answer to that question, he does not provide it here.

Pathologies of Power: Health, Human Rights, and the New War on the Poor
Paul Farmer
Paperback: 402 Pages
University of California Press

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The DNC Debate in Philadelphia: Horse Race

Tim Russert: Welcome one and all to Philadelphia. It is a beautiful day here at the racetrack. The sun is shining, there’s a little briskness from a fall breeze, and the candidates are parading around the track before the race begins.

Brian Williams: Yes, Tim. All the candidates seem to be getting ready for quite a race tonight. It should be fun to watch. Please put the white board away, Tim. It’s not election night yet.

Tim: I sorry.  I just get so excited.

Brian: Right. Anyway, on a sadder note, last night, candidate Mike Gravel was brought out back a shot prior to today’s race. Apparently, he hasn’t been performing as expected. That’s always a tough decision for any owner to make, isn’t it Tim?

Tim: Yes it is, but his owner, Tim Robbins, also owns candidate Dennis Kucinich and has decided to not continue Gravel’s suffering. A brave decision, I think.

Brian: On that note, let’s introduce the remaining candidates. Starting in the far left stall will be Chris Dodd. Chris was born and raised in Connecticut and is an underdog in this race. Unfortunately, because Dodd was born in Connecticut, he seems to face an affliction many inbred CT candidates face and often runs in circles. Dodd’s manager is really going to have to rein him in.

Tim: To Dodd’s right will be Biden and then ….Edwards! Look at that hair! I don’t think I’ve ever seen such a beautiful head of hair on candidate since JFK.

Brian: Well, Edwards did get into a bit of trouble a few weeks ago when the press got wind that his trainer spent $400 a pop on cutting his hair. It does look flawless though.

Tim: We’ll see if he musses it up a bit in the upcoming race. Next to Edwards is the indomitable Clinton. She stands a bit taller than all the boys. Oh, and is that, yes, it’s her husband, the two-time winner The Bill Clinton, standing in the shadows behind her. He was much more of a force earlier on in her training, but he appears to have backed off.

Brian: There were some early indications that this might be an ugly race especially for Madam Clinton. I mean, if you look closely, you can already see candidates Edwards and Obama stepping on her toes in the starter gate. We’ll see what becomes of this.

Tim: And speaking of Obama, he is up next to Clinton. Obama, an early favorite in these races, has come up disappointing. He has trailed Mrs. Clinton and has come in second in almost every race. He can’t seem to get that final push as the end of the race to push himself past the push reigning debate queen’s push. Right, Brian?

Brian: Candidate Obama has a tough choice to make during this race. Will he remain safely behind Clinton and try to ride her coattails to a position in her administration or does he come out, teeth biting and feet kicking, and try to take down the bitch?

Tim: We shall see. Looks like they’re getting ready to go with Kucinich and Richardson to the right of Clinton….AND THEY’RE OFF!

Brian: Oh no! In a tough break for Tim Robbins’ camp as Kucinich is distracted by an unidentified flying object and wanders off the track in search of it.

Tim: It’s always a shame to see a candidate beat himself like this.

Brian: The rough housing against Clinton has seemed to continue as Edwards and Obama have flanked her and are pushing against her on either side. She’s definitely fighting back though!

Tim: Yes, she is. Clinton has proven again and again that she can out run any of these guys in a one-on-one race. However, I don’t know how she’ll keep her stamina up with these two fellow candidates pounding her from either side. Not to mention, the Republicans, who had a race earlier, are throwing cups and food at her from the sidelines.

Brian: This is definitely getting ugly, Tim.

Tim: Brian! Why did you just throw a cup at Clinton???

Brian: Oh, I didn’t even realize. Just got caught up in the moment. Anyway, the candidates go around the bend. It’s Clinton up front followed immediately by Obama and Edwards. Richardson is trailing a little behind with Biden and Dodd taking up the rear. Kucinich is now in the woods singing a folk song about Energy policy.

Tim: And what is this? I can’t believe what I’m witnessing. It appears that Richardson has crept up behind Clinton and is…is…

Brian: He is licking her asshole.

Tim: Uh, yeah! I think that’s called a rimjob.

Brian: Apparently, he has already conceded. Actually, I don’t even think Clinton notices. In another note, Biden seems to be yelling. Did you notice that, Tim?

Tim: Yes, Brian. He’s been yelling for sometime now about “Iran” and “Experience” and no one really seems to be listening…  So they’re around the final bend now. Biden is skipping now and Dodd has starting smoking some of his “legalized” marijuana. He slowed down considerably since he started doing that.

Brian: That shit’ll mess you up.

Tim: Yes, indeed, Brian. So it’s Clinton, Edwards and Obama up front now. And oh my God! Clinton stumbles! Eliot Spitzer runs aimlessly onto the track and falls under her feet! THIS IS SO EXCITING!!!

Brian: Calm down, Tim! Anyway, Clinton stumbles. This is a chance for Obama or Edwards to catch up. They’re running…..oh no. They seem to be running into each other so much that they’re slowing each other down. Clinton has gotten up and just sprinted around them aaaaaaaaand Clinton wins.

Tim: Now that was an exciting end to this race!

Brian: You have some goo on your lapel, Tim. From all of us here at NBC, thanks for watching and we’ll see you at the next race.

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Mr. Thursday’s Book Shelf 9: Birds Without Wings

Mr. Thursday’s Book Shelf: Birds Without Wings

Written by Louis De Bernieres (better known for Corelli’s Mandolin and Nicholas Cage), this is the complementary story of a small, Turkish town’s identity in the face of a new brand new Turkish state. The consequences of World War I, the ascension of Ataturk, and the fall of the Ottoman Empire reflect upon this broken town of Eskibahce in southwestern Anatolia.

The story revolves around Eskibahce (Garden of Eden) and its residents. Muslim Turks and Christians of Greek descent live harmoniously in this out-of-the-way town. Although their religious differences are apparent, it is a regular occurrence for the Muslim women to approach their Christian friends and ask them to pray for them to the Virgin Mary. In the story of Philothei, the most beautiful Greek girl in the village, and Ibrahim the Mad, their religious differences make no difference to the lovers or their families. They are simply a good match.

With the start of World War I and the proclamation of a holy jihad, Muslim boys from the town must march off to war as their Christian friends remain behind to either be sent to work camps or to become out-laws and bandits in the countryside. Bernieres’ description of war electrifies and horrifies. The horrors of trench warfare are illustrated brilliantly and eloquently. Told from a first-person perspective (either experiencing it currently or through recollection) lends to a fuller understanding of the experiences.

Additionally, De Bernieres follows the story of Mustapha Kemal (Ataturk) and his rise through the ranks of the Ottoman military until he becomes the Father of Turkey. He never speaks through Kemal in first-person instead using his own omniscient voice, but he uses fictional village people, merchants, and artisans to express how the international and domestic power struggles affected life on the Anatolian Peninsula.

However, for me, the stories of individual struggles, which are expertly woven together, is the treat of this novel. Rustem Bey, the kindly but proud aristocrat of Eskibahce, and the conflict between his adulterous wife, Tamara, and his “Circassian” mistress, Leyla, is exceptional. The tensions of a man with financial stability and preeminence but who simply wants the true love of a woman is tragic. The appeal for true love is a universal theme. De Bernieres’ understanding of the human condition is the foundation of his expertly crafted prose.

Would I recommend this book? I’m not sure. It is a very slow burner, and it takes a significant number of pages before the plot gets moving.  Nevertheless, Birds Without Wings is a lovely read if you like historical fiction or beautiful prose.

Birds Without Wings
Louis De Bernieres
Paperback: 576 Pages
Vintage Publishing

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Mr.Thursday’s Book Shelf 8: The Sound and The Fury

The title of William Faulkner’s masterpiece is taken from a soliloquy from the fifth act of MacBeth:

To-morrow, and to-morrow, and to-morrow,
Creeps in this petty pace from day to day
To the last syllable of recorded time,
And all our yesterdays have lighted fools
The way to dusty death. Out, out, brief candle!
Life’s but a walking shadow, a poor player
That struts and frets his hour upon the stage
And then is heard no more: it is a tale
Told by an idiot, full of sound and fury,
Signifying nothing…”

Now I’m a good enough person to admit that Wikipedia gave me that little piece of information. Nevertheless, the title is as nearly a perfect title as I have ever seen. The Sound and the Fury is split into four sections.

The first section “April 7, 1928” is recounted from the perspective of Benjy, the youngest of the Compson boys. Benjy is either mentally retarded or autistic and this is expressed in the nonlinear, stream of consciousness of the first section. It is especially difficult to read and led me to put down the story multiple times; however, Benjy’s recollection of events in the Compson family (between 1898 and 1928) illustrate a pure sketch of the other characters in the family. It allows the reader to better understand each of the Compson children: Quentin, Caddy, and Jason.

The second section, and my personal favorite, follows Quentin around Harvard and through his recollections of Caddie at home before she becomes pregnant and is exiled from her family. Quentin’s despair for himself, and for his sister’s exile, lead to a nonlinear, cluttered end to the section until his suicide in the Charles River. It’s a complex and layered section.

My favorite part of this section is when Quentin meets an Italian immigrant girl. He spends the day trying to communicate with her to lead her home. He calls her “sister” and fruitlessly leads her around town trying to bring her to a house she recognizes. She follows him until her brother runs up, punches Quentin in the face, and claims that he kidnapped her. It’s beautifully written, and it displays Quentin’s tireless and futile effort to save Caddy from her fate.

The Sound and the Fury expresses the deterioration of southern values through the Compson family (it also expresses about a million other themes, but I’m going to focus on this one. I’m not an English major after all). The alcoholism and death of the Compson father, the mother’s insistence that the family maintains the aires of aristocracy, Caddy’s moral degradation, and when her daughter, Miss Quentin, ran away with a carnival man are all indications of the deterioration of the family. It is through Dilsey, the Compson’s matriarchal servant, that the family is mourned.

The Sound and the Fury is a beautiful work, and a major reason for Faulkner’s Nobel Prize in literature in 1949. This book is widely regarded as one of the best in American literature. It’s beautiful, lyrical, and challenging prose. It must be read more than once.

The Sound and the Fury
William Faulkner
Paperback: 336 pages
Vintage International

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Where You See Lions?: A Closing

 

The memory of Kenya is all I have left. I remember the overwhelmingly green hills and mud rivers. I remember the crowds of children in high-pitched nasally voices yelling “How are you? How are you?” over and over at me. I remember getting stuck in African rain, mud clinging to the back of my legs, waiting for the rain to let up shivering under a banana thatched matatu stop. I remember the old mamas dancing and singing me down the road, grasping my hands, and asking me to return again one day.

The situation of Africa currently is dire. It’s not only the fault of corrupt governments or environmental disasters or inadequate international aid or deteriorating infrastructure or endemic disease or any number of other causes. Africa is in a dire situation because all of these causes feed and intertwine with one another to delay or eliminate positive effects. I am not suggesting that Africa will forever be subject to persistent poverty, disease, and death. I am suggesting, however, that the international community in conjunction with African political, community, and tribal leaders must act now and quickly to avert or prevent future disasters.

Currently, in the Democratic Republic of Congo (DRC) there are unspeakable acts of violence going on destroyed psychologically from the 1994 genocide have been carrying out crimes against humanity in eastern DRC. Rape and brutality are becoming everyday occurrences for the people of villages and communities. Although there are 17,000 UN peacekeeping forces currently in the region, the DRC is close to the size of Western Europe and the third largest country in Africa. Peacekeeping is an uphill battle, and those living in these communities are running out of time.

In the horn of Africa as of today, there is a drought effecting millions of lives. Ethiopia, Somalia, Kenya, and Tanzania among others are directly impacted by this environmental disaster in the making. Somalia is already fragile enough that a highly disruptive event such as a drought could send the country into a downward spiral fostering terrorism, war, and death. Somalia will not be able to weather this drought without sustaining international emergency aid and continuing grants and loans afterward to reestablish the economy.

I love Kenya. I love Africa. But there are problems on the continent that are beyond their resources. I am looking forward to returning as soon as possible to Kakamega. If not there at least to a new place in Africa. The beauty, the sadness, and the resilience of the people of Africa is astounding.

To end Where You See Lions? I’d like to share a few excerpts of my journal during the summer.

July 10th, 2007

“Yesterday, I went to Khayega with Bridget, Janet, and Ana to take a look at a program that CARD (Janet’s organization) holds every Saturday. It’s free VCT services (Voluntary Counseling and Testing) for HIV/AIDS. Each councellor meets with people for between forty-five minutes and an hour to speak of life style habits, high risk activities, etc. in a confidential setting.

I think it’s amazing the way it’s set up. There is a comprehensive evaluation and counseling before a person learns their HIV status. Additionally, they have a DJ playing music and theater groups performing in order to make it more inviting. Honestly, it’s a fantastic program.”

July 13th, 2007

“Last night, I fell asleep pretty peacefully until about 11:30pm. I wake up feeling something in my hair. Naturally, I freak out a little, fuss at my hair, feel around in the dark. I don’t feel anything so I lie back don. Then something (a roach) climbs on the top of me and bites my hip. I scream horribly and wake up Judith. I hate those roaches.”

July 20th, 2007

“After my first month in Africa, I can confidently say two things. I don’t understand Africa. I understand why people love Africa. I have only been to Kenya, but it is the kind of place that I could be happy. There is terrible corruption, roads are atrocious, disease is ubiquitous, and money is scarce. At the same time, family is essential, money is secondary, and community comes first. ”

August 3rd, 2007

“Mayowa and I saw it was going to rain so we grabbed bodas and headed back to Azare. Well, wouldn’t you know that half way there, it started to pour and my boda wouldn’t continue. The roads are awful in Matioli so I can understand why. But after fifteen minutes, I decided to walk the final mile to Azare. It was hateful. I was soaking wet and muddy when I arrived. I saw Mayowa shivering in the rain and sat next to him.

We waited two hours for a matatu but none came. The roads were too bad and the rain did not let up. So we called a taxi to get us. The taxi took another hour at which time two matatus came by. However, they preceeded to get stuck in the mud one by one. So when the taxi came, I was happy to my way down the hazardous road to Shibuli. When I arrived home, I was wet, muddy and cranky. But I was home.

The following day, I wake up at 5:45 am to get to Milimani. I spoke to Janet, and she was telling me that I had to get there by myself. Okay, no big deal.

I get a matatu out past Lubao and deal with an hour trip of being hit on by some older guy who wanted a green card in the U.S. I switch matatus at Junction and go to Turbo silently screaming the whole time because honestly, I have no idea where I’m going.”

August 10th, 2007

Paulina, mtoto mzuri, Paulina kiba
Paulina, mtoto mzuri, Paulina kiba

Habu cheza qua maringo tukuonae kiba
Habu cheza qua maringo tukuonae kiba

Eba chikicha chikicha eba (Repeat)

August 19th, 2007

“I am in Uganda overlooking the source of the Nile. I am tired, beat up, and my skin hurts. But I am absolutely happy right now.”

August 21st, 2007

“I am currently at the end of my final theater workshop in Butere. I thought this was going to be difficult. Now, I could do this lecture with my eyes closed. In addition, I am beginning to memorize the Shakespeare by heart, which is nice…

I really like the Butere CBO. Maybe the reason they are so good is because of Zablon. Maybe not. But they work hard, they’re fun to be with, and I enjoy teaching this group. I hope that I’ve actually made an impact.”

August 26th, 2007

“It was both how I imagined it and how I couldn’t have imagined it. Kibera was further than anything I have ever personally experienced. It was very difficult to imagine daily life there even with it in front of me.”

August 28th, 2007

“I am definitely excited to be in Amsterdam. Another country to add to my map. I’d like to go to Vietnam, Iceland, Ghana, and Senegal. Those are my top destinations now.

The guy next to me just pulled out a laptop in at the train station. I am millions of miles away from Kenya.”

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Where You See Lions 4: Who’s Nostradamus?

The predictability of the weather in Western Province has proved an unexpected but welcome addition to my trip. I know that everyday at 4pm it will start to rain. I know that everyday at noon is will be dry and hot outside. I know every night will be cloudy (except for those rare, clear, and stunning nights without light pollution). This consistency can be charming and infuriating. I know everyday when I am trying to get a matatu home, it will be raining. But I also know to bring a raincoat in the mornings. It’s an interesting mix of both.

In contrast, the people of this country are not nearly so reliably predictable. Last week, I managed two workshops at two different locations near Kakamega. The locations were Burkura and Lugari (click on the map on the right–Kakamega, Lugari nad Burkura are circled). The workshops were concerning theater and microfinance. However, the reactions, experiences, and evaluation couldn’t have been different.

Burkura is a small town up a steep hill about 20kms outside of Kakamega town. Luckily, it’s only about 5kms from the village I am living, Shibuli. Nevertheless, it takes a good two hours to travel up the bumpy, treacherous and frequently cattle-prone road that leads to Burkura. In order to reach the Community Based Organization (CBO), which is not located in Burkura but in a smaller village called Matioli (which I’d like to point out was not related to me that first time I went to see the CBO) you must take another matatu and then a boda boda. The scenery is beautiful and on a clear day, you can see Mount Elgon from up there.

Nevertheless, what I discovered in Burkura are youth groups desperate for information and motivated to put acquired knowledge into action. They read Shakespeare with vigor, wrote plays with enthusiasm, and participated as often as possible. The Burkura CBO became a model, to me, for how Kenyan CBOs should behave. If nothing else, the fact that the people were friendly definitely helped.

However, Burkura has a merciless side to it as well. On the final day of the workshops, as I quickly tried to patch up loose ends, it started to rain. And it didn’t stop. Because the roads in Kenya are unsurprisingly dilapidated, paved roads are difficult to maneuver in the rain. A dirt road is nearly impossible. So when my bodaboda decided to stop a mile away from the matatu stop, I had to press on with the other volunteer and wait for three hours in the rain for a matatu. So it goes in Kenya. (We called a cab).

The following day, I went out to Lugari. Lugari is much farther away from Kakamega (about 30 miles), and it took five hours to get there. Unfortunately, the trip should only take three so I was late. Lugari was a disappointment on every level that Burkura was pleasure. The participants were immature, the director was only concerned with getting his hands on some muzungu money, and African Time took new levels of tardiness.

(Now, African Time deserves a moment of explanation.  Obviously, this refers to the way people observe time in Africa. If you plan a meeting for 9am, people begin to arrive at 10am. You should be able to start the meeting at 11pm. You will receive your final stragglers arriving around 1pm, when you’re trying to leave.)

Now, these two experiences should have not been too different. I had the same number of participants from the same organization with the same workshop. But this is how it goes in Kenya, Sometimes things work fabulously and sometimes they fabulously fall apart. This is not an indictment of one CBO and accolades for another, but simply an example that, here, things never work the way you think they will. People are unpredictable; fortunately, the weather is not.

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Where You See Lions 3: People

kenya.jpgThe types of people you meet in Kenya are as varied as the kernels of maize in the hills…uh, songs by Yvonne Chaka Chaka, whatever. Truly, the people of Kakamega, Kenya have been marvelous and disappointing and heart warming and tragic. However, there have been a few certain types of people I have come to know so far that have been replicated more than a few times since I’ve arrived. Just as in America, you can identify your hipsters, Reganite yuppies, and hip-hop wanna -be’s, so in Kenya, there are some types easily identifiable. Each type has its benefits and detriments, but all of them are peculiarly spectacular.

After the break, a look at a few of these prevalent groups of people.

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