Africa revisited through the Dark Star Safari

From the comfortable security of my modern cocoon in Seattle, Wash., I am vicariously reliving some long-ago travels I made in Africa during the summer of 1997, which already was 15 years ago. I have the often cynical but always observant and honest Paul Theroux to thank for being lifted out of my quotidian boredom and back to my brief five-week journey in central and East Africa.

Sunrise on the Serengeti, a magnificent sight indeed.

In June 1997, I travelled to Rwanda, just three years after the genocide. I arrived there, hoping to try my hand at freelance journalism and perhaps cover some of the genocide trials that were underway in the aftermath of the horrific crimes against humanity. I lacked two of the most critical elements to pull this off: connections and cash. Maybe I lacked cajones too. I also was floored by malaria once I arrived in Kigali, Rwanda, and I pulled out in two weeks, having lost a lot of weight and having determined I would not have the resources to succeed in my original plan. As to whether I would have succeeded as a freelancer if I stayed longer is hard to say, as Rwanda then was in the throes of an incredibly violent civil war that had claimed thousands of lives. That conflict, which involved the stopping of microbuses—like ones I was riding—and the slaughtering of all passengers, was pitting the Tutsi-led forces of the new post-genocide government of Rwanda against the extremist Hutu militias who had taken hold in then eastern Zaire. This was just before Zaire’s own meltdown into violent civil war, tribal violence, and foreign interventions that remains unresolved to this day.

Passing the time in Moroti, Uganda, on my way to the north of the country in 1997.

Theroux’s book, called Dark Star Safari, is typical and classic Theroux. It recounts a year-long trip he made from Cairo to Capetown in the early 2000s, mostly by land transportation, using local means such as the back of trucks, buses, microbuses, and sometimes rides in Land Rovers and overland safari trucks with the many white Westerners he sees. Theroux is unforgiving in his criticism of both Africans and of outsiders, who are mostly Westerners but occasionally Indians, Japanese, and Chinese. Theroux often savagely skewers this mostly Western crowd as if they were the marabou scavengers, the quite ugly and ubiquitous large storks seen throughout eastern Africa, which lurk about and wait for carrion to devour.

I like Theroux because he attempts to put what he sees into context, with the perspective of a man who spent two years of young adulthood as a Peace Corps volunteer in Malawi in the 1960s and later several years as a lecturer in Kampala, Uganda, before the despot Idi Amin took over and destroyed that nation. To his credit, Theroux’s comments on the failures of aid projects, for instance, are based on his first-hand encounters. He credits foreign aid organizations and Western governments for creating a culture of aid dependency in many African nations. But his biggest target is corruption by African leaders and its military and civilian rulers. Writes Theroux of the large cities he visited and detested on his trip: “Scamming is the survival mode in a city where tribal niceties do not apply and there are no sanctions except those of the police, a class of people who in Africa generally are little more than licensed thieves.“

Traveling by bus in Uganda, rarely a dull moment.

I have exchanged a few emails about this book with a friend of mine who also did a Peace Corps stint in Africa and who thought Theroux was honest about what he observed. I told my friend that Theroux’s description of traveling through a inhospitable, mostly lawless area from Mega, Ethiopia, to Isiolo, Kenya, where two white Westerners refused to give him a ride in their Land Rover, brought back my own memories. Like Theroux, I saw plenty of those same Land Rovers in Kenya, Rwanda, and Uganda and also never got a lift. (Did I deserve one—no, but they could have been offered; I did refuse a ride once too because I wanted to walk, but the driver was African and a decent guy.) I too wondered who are these privileged outsiders anyway? I remember distinctly two haughty U.N. officials—an African and European—sniping like French lords at low-paid Rwandan hotel staff while wearing stylish dark shades and expensive suits, angry dust got on their suitcases, as they disembarked at Milles Colines Hotel, made famous during the genocide where Tutsis hid while surrounded by killers. The cost for a room in 1997 was about $150 a night as I recall, or about half of what a Rwandan then earned in a year. I could not afford the place and luckily found accommodation with a great aid worker I met who I thought was doing good work.

Like Theroux, I travelled by truck to some remote parts in the bush. This trip took about 12 hours and was among my most memorable.

I also remember Italian missionaries in Northern Uganda, near Karamojo, in the deep bush who ran a furniture shop and spoke the local language and seemed completely at ease and in their element — like some of the Italian missionaries Theroux met in Ethiopia and Kenya. And, like Theroux, I remember these “overlanders,” the white tourists on coverted safari trucks crossing Africa, when I stopped at Lake Naivasha, Kenya. In my case, the passengers expressed excitement about seeing mountain gorillas in Rwanda without having a clue about the raging conflict there or another violent uprising that was occurring in southwest Uganda. And one has to wonder about two female aid workers he disparaged for their peddling of a Plumpy’nut type nutritional food product to poor children in person cause they reportedly didn’t trust the mothers to deliver the aid themselves? Is that true? I believe it is. Just this spring I heard an announcement by U.S. AID that the United States is pushing corporate food aid with corporate food giant Pepsico, in Ethiopia. What’s good for Pepsico is also good for U.S. AID and Ethiopians, if I am to believe the facts in this press release.

Anyway, not everyone agrees with Theroux, and here’s one attack, by John Ryle from 2002 in the Guardian, of the book and of the writer himself. Personally, I think Theroux is smart and clearly sees the public health, economic, political, and outsider-driven problems that challenge the countries he visited. I also do not think one sells books being nice or being 100 percent true. Theroux is a strong brand, and you know what you get when you read his brand. And it remains exceptionally enjoyable.

I shot this photo near Mt. Karamojong, a mountain that is home to a rebellious group who were known to rob locals with AK 47s when they were not fighting with other cattle raising tribes in Kenya. Or maybe they are just a tribe trying to survive in a land with few resources and many threats.

My blog changes its name, and a few bits on public health blogging

On Sept. 26, 2012, I did a little behind the scene tweaking to my blog, which now celebrates its seventh month on the air. (I love it.)

I created a subdomain, which means my blog name is now tied to my web site of www.rudyfoto.com. All past links and references to my blog URL (https://rudyowensblog.wordpress.com) will now be linked by my blog URL (http://iwonderandwander.rudyfoto.com). Nothing else has changed. I wanted to link my blogging more with my web site. I also, in the next month or two, plan to reboot my web site and rebuild it to highlight my photography and multimedia in a more user-friendly format. Stay tuned for that.

On an upbeat note, the University of Washington School of Public Health has linked to this blog on its page for prospective new students. I was not expecting that, but it was very refreshing and positive to see. There are some other great bloggers listed there. Way to go public health bloggers, you are the future. For instance, here is how the University of North Carolina at Chapel Hill Gillings School of Global Public Health promotes its bloggers, including students (wow, that is a heckuva long name for a school — and I am a UNC-CH alum who took classes there back when I was studying journalism in 1991-93.)

My thinking remains that blogging and other social media tools must be embraced by the field of public health to communicate to wider audiences and to share research from behind the firewall, which prevents the public from accessing many peer-reviewed research articles, where public health traditionally seeks validation and where the field encourages its professionals to publish. To that end, I am confident it will be future graduates of schools like the UW School of Public Health who will create change and transformation in the field to make the concepts and value of public health more accessible and meaningful to the mainstream public and policy-makers.

Dogs and pets provide meaningful therapeutic benefits

A smile and a wag — the universal language of happiness.

Today I read yet another article on the healing power that dogs have for humans who have experienced trauma, in this case sexual abuse. According to a Sept. 23, 2012, story in the Seattle Times (Courthouse dogs calm victims’ fears about testifying), King County Washington’s seven-year-old practice of using assistance dogs to provide comfort to victims in a courthouse setting has been deemed legal in an appeals court ruling. I have previously written about how pets are used in prison settings, leading to better outcomes for both the state and prisoners (see my May 3, 2012, post: Cats behind bars — more proof of how pets bring out our best). I do not think it is a surprise to anyone who is familiar with the value of using therapy dogs that dogs could and should be used to assist young persons who are crime victims. They are commonly used by many people with illnesses and disabilities, like this instance with a college student who has spina bifida.

The powerful bond between humans and dogs is well-known and about as old as civilization itself.

In this particular case reported by the Seattle Times, a lab-retriever mix named Jeeter helped two female victims of molestation heal and also testify in trial, as a means to alleviate their reported fear and discomfort. The decision deemed the dog to be a neutral agent, not siding with either party in the legal process and being an equal opportunity dispenser of affection. As one of the two females victims told the Seattle Times, “What we want people to know is that they can have a dog to help them, too. We’re not ashamed about what happened. We didn’t do anything wrong.” In fact, the Seattle Times reported the National District Attorneys Association passed a resolution last year supporting the use of courthouse dogs.

Another famous instance of therapy dogs being used to assist crime victims was at the campus of Northern Illinois University, where a murderous gunman killed five students and injured nearly two dozen others in 2008.

As the final report on that gun-related massacre from NIU highlighted, in addition to more than 500 counselors who assisted victims and the campus community, there were dozens of volunteers who assisted by bringing “comfort dogs” to the NIU campus in DeKalb, Ill., after the shootings. The report noted, “many of our students hugged those wonderful dogs and wept openly, some for the first time since the tragedy.”

A wonderful book that I read this summer on the powerful bond between humans and other species called Kindred Spirits: How the Remarkable Bond Between Humans and Animals Can Change the Way We Live, by DMV Allen Schoen, highlights how powerful this connection is, including on the health of humans and the species with whom they interact. Schoen has attracted attention for research and efforts exploring the ways science and larger culture understand how humans interact with their many animal friends. His description of his former golden retriever, who he rescued and who then became his assistant caring for his animal patients, is wonderfully touching. He eventually had to put his beloved assistant down. When I shared this book with a member of my family, she broke down into tears, thinking about her former dog.

My former grad school experience vastly improved when I moved into my new apartment and made friends my always cheery neighbor, Balloo.

Schoen has his own web site and a blog here: http://www.drschoen.com/. His web site notes that he continues to practice what he calls integrative veterinary healthcare, which brings together holistic and natural techniques such as acupuncture and homeopathy along with the best of conventional veterinary medicine to provide animal healthcare services.

There are peer-reviewed journal articles being published about the power of animals, including in the work setting, where an abundance of anecdotal reporting and research has occurred. An Associated Press story from Feb. 9, 2012, described the “growing phenomenon” of dogs in the workplace in America, according to Rebecca Johnson, director of the Research Center for Human-Animal Interaction at the University of Missouri’s College of Veterinary Medicine, in Columbia. “People are realizing we need to do things to reduce stress in the workplace,” Johnson told the AP. She said dogs can build connections among co-workers and create healthy diversions from work. People interacting with dogs have a hormonal reaction that causes them to “feel more relaxed and more positive.”

All I can say is that nothing beats a dog or purr on a bad day. Even the worst day improves the moment there is that amazing interspecies contact.

A primer on the futility of buying health insurance in the open market

On Sept. 19, my University of Washington graduate student health insurance plan expires. I paid $607 a quarter last year, four quarters a year, for two years for this plan. It was OK. I never really “used” it for anything. I did have my knee looked at, and a finger was inspected once that got dislocated that I actually fixed, but no real “medical care” was ever provided except consultation. Only one visit really required a specialist’s expert analysis, but I actually deduced a similar conclusion from online research. Short of a medical test, even that expert opinion was just that, an opinion. So I am left wondering what this investment served. It did not cover in-house physical therapy, massage, or chiropractic care—all forms of medical care that I truly believe promote health and wellness without expensive, harmful pharmaceuticals and that use non-invasive techniques to promote healing through touch and manipulation of the body’s muscles and skeletal system.

Massage should be covered at higher levels by all insurance plans, as it provides excellent health outcomes with few negative effects and no medication.

I was supposed to cover those expenses “out of network” at 60%. As a former graduate student, I had to weigh medical care versus, well, paying for food and rent, and I simply put off the care I needed the most and used to get when I had a plan with my former employer in Alaska – chiropractic care and massage therapy. There were times I was in excruciating pain that simply had to be ignored because my insurance did not cover it, and those problems could have been addressed if I paid for much of it, after my deductible.

So now I am in the open market of insurance again. This is that wonderful place where the “invisible hand” of Adam Smith is supposed to provide solutions without “government interference.” Well that is not the case. The market is somewhat regulated by the Washington State Insurance Commissioner. They put together a good web site to help consumers understand the nine companies that offer health insurance plans in this state and the types of plans available to them. I think they did a good job.

Such communication for consumers is critical, as insurance companies prefer to communicate in “insurance speak” language involving legalese and jargon such as “co-pays,” “deductibles,”  and let’s not forget “pre-existing conditions.” Here’s just a taste of one clause from one plan on how they try to limit coverage for a “pre-existing condition”:  “Pre-existing conditions: these plans contain a nine-month pre-existing condition clause that excludes coverage for any condition for which there has been diagnosis, treatment (including prescribed drugs), or medical advice within the six-month period prior to the effective date of coverage, for which a prudent person would have sought advice or treatment. Section 6 of the application for our individual and family plans will help us determine whether you have creditable coverage, which would allow [COMPANY NAME REMOVED BY AUTHOR] to waive pre-existing conditions/exclusions for you and/or your dependent(s).

No, choosing insurance is never easy because the language is often confusing and many non-experts cannot decipher the fine print of the  brochures with happy, smiling people used to lure in customers.

Such language is not simple or easy to understand, and in theory, the Patient Protection and Affordability Care Act (health insurance reform passed by Congress recently) will make it impossible for insurance companies to deny persons health insurance in the future because of a pre-existing condition. It is not clear if non-English speakers can understand this information at all. While many people have fought with insurance companies, many lower-income or less-educated persons may not have significant experience navigating complex legal documents that, quite frankly, I think people with MBAs or law degrees do not fully understand. Here are two companies’ plans that offer health insurance to individuals in the state of Washington (there are exactly nine corporate players in this limited market): LifeWise, Group Health.

I chose LifeWise. I am waiting for them to approve my plan. I will have to have proven I actually had coverage before (I did as my UW plan was owned by them) and am likely not a deadbeat. I am sure they are probing my legal, credit, even personal records as I write this to determine if I have been an actuarial risk to providers, if I have some terrible health condition that would harm their profit margins, and if I am generally on the up and up as a possible customer to help them make a “reasonable rate of return,” which is really all a company can hope to do. This all is, of course, unlike other developed democracies, because our country continues to refuse to adopt a single payer plan that other countries like Canada and France have taken up with better population health outcomes for their citizens and less gauging of consumers.

So what will I get if I am approved? I signed up for the basic catastrophic plan called “Wise Simplicity”. I would pay $160 month as a nonsmoker, and have a $10,000 deductible (compared to an $1,880 deductible that would cost me about $370 a month). So if I am hit by a car, I pick up the first $10,000 out of pocket? Great, eh?

So what do I get with the barebones plan? Well, basically a plan that tells me not to get sick and certainly don’t have an accident that costs $9,999.

I simply cannot afford another plan now. And this deeply worries me, until I get a job with coverage (and that is coming soon – yeah!). Two people I know in my immediate circle of friends just had enormous medical bills. One friend had elective knee replacement surgery. I cannot imagine that is less than $50,000 to $100,000 in costs (surgeon, anesthesiologist, several nurses, equipment, rehab, etc.). Another friend had a horrible and likely allergic reaction to a standard immunization and developed a syndrome that sent them to the hospital, where the same issue ensued with specialists, etc. My friend guessed the bills before insurance will be at least $100,000. So as I bike down Seattle’s dangerous roads, avoiding cars that do not know I am there as the driver texts a message about whatever, I contemplate just how flimsy my health care coverage really will be come Sept. 20. I guess the answer is what some running for office suggest – just don’t get sick. You know what I really do not have a choice. Adam Smith’s invisible hand I guess is making that possible, but why do I feel more like the hand is choking off my air supply and giving me a sucker punch when I am not looking.

Cheap energy poses a threat to Americans’ health

One of the most talked-about initiatives taking place in public health, with funding supports from the Centers for Disease Prevention and Control (CDC), is policy, system, and environmental change to address the rise of chronic disease in the United States, the country’s leading cause of death. According to the CDC, chronic diseases are responsible for seven out of 10 deaths of all Americans annually, and one half of all Americans have at least one chronic illness. Worse, three-quarter of the $2.5 trillion (yes trillion) dollars spent annually on health care in the United States goes to battling chronic diseases. The CDC’s grant funding is being disbursed to health departments to undertake a range of interventions. But none of these interventions is going after what some say is one of major sources for the rise of obesity and chronic disease—the cheap price of energy in the United States.

According to Ian Roberts of the London School of Hygiene and Tropical Medicine, the overall obesity rate is highest in the United States among all other nations because the price of gasoline is very low. “So where gasoline is really cheap, we over-consume it, it’s bad for the environment and actually because we should be using food energy for human movement – if we use gasoline for human movement, then we store the food energy and you know where we store it.” And there are other costs associated with being a fat nation, says Roberts. “So there’s obviously an increased demand on food supplies, but also there is an increased demand on everything. You know, bigger people need more energy to move them. Airplanes take more energy to get off the ground. It takes more of the shares that, you know, of the Earth’s resources to actually support all that extra weight.”

In the United States, the U.S. Energy Information Agency estimates we use 317 million BTUs per person a year. In this country, nearly half of all of our energy comes from petroleum and natural gas, and the country ranks seventh globally in terms of per capita energy use, trailing Canada and some smaller nations like Luxembourg and Trinidad and Tobago. However, the United States is  No. 2 (19% of global demand) in terms of global consumption of energy after China (20.3% of global demand), which just took the No. 1 slot.

Feeder pipelines gather crude oil produced at Prudhoe Bay, which is eventually shipped to the lower 48 for consumption on the West Coast.

A significant negative outcome can be seen in the widening waistlines of Americans. Charles Courtemanche of the Department of Economics at the University of North Carolina at Greensboro published a study in 2009  (A Silver Lining? The Connection Between Gasoline Prices and Obesity) that found increases in gas prices were associated with an uptick in walking or bicycling and public transportation use (and more people walking to bus and subway stops) and a drop in the how often people eat at restaurants, all impacting weight. Courtemanche estimates that:

– A $1 rise in the price of gasoline would reduce overweight and obesity by 7% and 10% in the U.S. The reduction in obesity would save approximately 11,000 lives and $11 billion per year, savings that would offset 10% of the increased expenditures on gasoline.

– An 8% of the recent rise in obesity from 1979 to 2004 can be attributed to the decline in real gasoline prices during the period.

According to Dr. Brian Schwartz, professor at the Johns Hopkins Bloomberg School of Public Health’s Department of Environmental Health Sciences and co-director of the School’s Program on Global Sustainability and Health, cheap energy also is responsible for creating our built environment, which is exacerbating our poor health trends. Schwartz argues that since World War II, the United States and other developed countries “have invested in large tracts of low density, non-compact, single use developments, which are highly reliant on the automobile and often lack public transit options.  This type of housing and transportation system is totally reliant on cheap and plentiful oil.”

The built environment of U.S. suburbs has been shaped by the relatively cheap price of petroleum paid by U.S. consumers at the pump.

Schwartz argues the average foodstuff in the United States requires about 10 units of fossil fuel-based energy input for each unit of food energy derived from the food, and that ratio jumps to 100 to 1 for many meats. Less energy would lead to declines in food calories too, as many kinds of food would become too expensive to produce and too expensive for consumers. What’s more, Schwartz suggest that this unsustainable suburban lifestyle would change dramatically after peak oil, that future and historic moment when global production of both oil and natural gas reaches its historic peak and begins to decline, setting off chain reactions impacting every facet of our life to what we eat, how we work, how goods and people move about, and how nations respond on a massive scale. (Go here for a summary of peak oil and its health impacts, as explained by Schwartz.)

Schwartz also notes that our entire health care delivery system, on top of our suburban-sprawl development pattern, food production systems, and supply chains, also is tied to unsustainably cheap energy in the form of cheap fossil fuel. “Large energy-inefficient health care facilities are staffed by health care workers living in distant suburbs who require large quantities of paper, plastic, and electronics to do their work. Systems for provision of care will need to be completely redesigned to adapt to the new reality of more expensive energy.”

Portland, Ore., that oh-so progressive Northwest city that has become a beacon of contemporary planning that tries to vaguely resemble what they do in Netherlands or Denmark, for instance, already has assembled a Peak Oil Task Force, back in 2006. The group prepared a report and drafted a resolution, passed by the City Council in 2007. That resolution sets out an ambitious goal to “reduce oil and natural gas use in Portland by 50 percent in 25 years and take related actions to implement recommendations of the Peak Oil Task Force.” It may be no surprise Portland was recently ranked the No. 1 biking community in the United States.

What continues to baffle me is how unengaged or willfully silent the United States’ professional public health system is to the connection between cheap energy and health, notably obesity. I just did a keyword search today (Sept. 3, 2012) on the word “obesity” for the upcoming American Public Health Association (APHA) Annual Meeting and Exposition to be held in San Francisco in October 2012. There were 797 hits for the word–many for papers being presented on the topic. When I typed in the word “oil” I yielded 33 hits, some on the Deep Horizon oil spill and its impacts and others on shale gas development, such as a paper being presented by Dr. Roxana Witter of the University of Colorado called “Comprehending health implications of natural gas development through public health research.” But I saw no papers on any linkage between the so-called “obesygenic environment” and energy prices tagged under the word “oil” in the searchable database of presentations and papers. I did a search for the word “energy” and got 82 hits, but most related to topics like high-energy drinks, not on oil, gas, or energy policy issues impacting human health.

Seattle like other cities is entirely dependent on relatively cheap petroleum, and as a consequence suffers from some of the worst traffic congestion of any metro area in the country, as well as a sprawl development in the city and throughout surrounding King County.

I dream of the day when public health professionals will organize their advocacy less around what kids eat at school and talk more about what our state and national lawmakers are doing to create meaningful tax policy that prices energy–making it more expensive while using revenues to promote renewable energy sources–to create larger downstream impacts. To completely cede this issue to supporters of cheap energy and the status quo and to deny that there are serious public health implications by doing so is to turn one’s back on best available evidence and the duties those in the field have to promote healthy outcomes for the U.S. population.  I did try to raise this issue in one of my classes at the University of Washington School of Public Health, and was met with unusual silence. I hope one day perhaps UW faculty in the economics department, school of business, and schools of public health and public affairs get together one day to pursue research examing negative health impacts of national energy policy.